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ON EPIDEMIC CHOLERA. 



EDINBURGH : T. CONSTABLE, PRINTKR TO HER MAJESTY. 



A TREATISE 



EPIDEMIC CHOLERA 



J.°TUTHERFIJRD RUSSELL, M.D. 



//■<%-//-; 



WITH AN APPENDIX OF CASES TREATED IN THE EDINBURGH HOMOEOPATHIC 

DISPENSARY, 1848-4.0, AND A MAP SHOWING THE COURSE OF THE 

CHOLERA FROM INDIA TO BRITAIN. 



LONDON: 

WILLIAM HEADLAND, 15, PRINCES STREET, HANOVER SQUARE; 

HYPPOLITE BA1LLIERE, 219, REGENT STREET. 
EDINBURGH: MACLACHLAN & STEWART; E. ALLSHORN, 63, HANOVER STREET. 

MDCCCXL1X. 



Rutland Square, June 1849. 

My Dear Drysdale, 

To you, as to an elder brother, I dedicate (without 
permission) this first publication of mine which has appeared 
without your name as well as my own on the title-page. Accept 
it as a tribute of affectionate respect for your character, and as the 
token of a friendship (esto perpetua) which has now lasted without 
interruption for the best part of twenty years. 

Yours truly, 

J. RUTHERFURD RUSSELL. 

J. J. Duysdalk, Esq., M.D., Liverpool. 



*- ..." .-»■ •._,.' \_faS*d 



CONTENTS. 



INTRODUCTORY CHAPTER. 

r.-ijics 
On Epidemics in Genkkal 1-19 



CHAPTER I. 

On Epidemic Choleua. 
Its Maucli, . . 20-52 

CHAPTER II. 

Is IT CoNTAdlOUS? 53-89 

CHAPTER III. 

Its Pathology. — Predisposing Causes — Exciting Causes — 

Proximate Cause — Morbid Anatomy, .... 90-167 

CHAPTER IV. 

Its Symptoms, 168-186 

CHAPTER V. 

I ts Treatment. — Camphor — Arsenic — Arseniurettcd Hydrogen 
— Veratrum — Cuprum Metallicum — Cuprum Aceticum — 
Secale Cornutum — Nux Vomica — Lachesis — Crotalus Hor- 
ridus — Lachesis — Hydrocyanic Acid — Cicuta Virosa — To- 
bacco — Tartarus Emeticus — Carbo Vegetabilis — Oxalic Acid 
— Phosphorus — Mercurius Solubilis — Mercurius Corrosivus 
— Ipecacuanha — Chamomilla, 187-273 



Vill CONTENTS. 



CHAPTER VI. 
On Epidemic Cholera in Edinburgh, 274-288 



APPENDIX. 

Cases Treated at the Homceopathic Dispensary, Edinburgh, 

in 1848-49, 289-353 



PREFACE. 



That the Cholera, which is now committing such 
frightful havoc in Paris, will, before long, prevail as an 
epidemic in this country, hardly admits of a doubt ; and 
while it would serve no good purpose to conjecture the 
particular places which it is most likely to select for its 
first invasion, it is obviously the imperative duty of all 
to be prepared to do their utmost to mitigate the suf- 
ferings from a pestilence which no human power can 
avert. How much may be done by a judicious antici- 
pation of the event is shown by what took place in 
Edinburgh. The subject had been considered by the 
Committee of the Homoeopathic Dispensary a year 
before the cholera made its appearance ; and three 
days after its existence in Edinburgh was announced, 
our whole machinery was in full operation. We were 
the first in the field, and the consequence was that we 
treated about a fourth of all the cases of cholera which 
occurred here. This we could not have done but for 
the liberal support given us by our friends. Not only 



PREFACE. 



were we enabled to meet the unusual outlay required 
for keeping the Dispensary constantly open, but a fund 
was placed at our disposal by which we could relieve 
the most destitute after they had recovered from 
cholera, and thus float them over the period of conva- 
lescence, and save them from starvation or pauperism. 
The good thus effected was very great ; and we only 
regret that the supply was so temporary. We cannot 
but think that the physician is the proper channel of 
relief to the poor ; and that if it were possible to have 
a relief fund attached to each Dispensary, hundreds 
might be saved by it from falling upon the parish. 
Just consider how directly and unerringly all the money 
given goes to its destined object — not a penny is spilt 
by the way ; and compare this plan with the cumbrous 
one of parish officers, inspectors, and all the expensive 
machinery of ordinary relief. But, moreover, look to the 
immeasurable moral superiority ; death is the great level- 
ler of rank, and a deadly disease begets a certain feeling 
of brotherhood between the sick and the attendant. To 
take money from the hand of such an attendant at 
such a time brings with it no sense of degradation ; 
and if the physician tell the poor sufferer that he him- 
self has received the money from a kind friend for the 
purpose of relieving him, the noblest sentiments of gra- 
titude to the unseen donor are called forth. And how 
easily could such a fund be raised ! During the preva- 
lence of cholera, from one individual— and one not rich, 
except in good works — we received a guinea a-week, 



PREFACE. XI 



obtained from benevolent persons who readily contri- 
buted to so manifest a charity. Why should such a 
stream as this not be perennial ? If we could afford to 
have a permanent house-surgeon, and a relief fund to 
the amount of a guinea a-week, to be laid out in food 
for patients recovering from severe illness, we could 
confer an incalculable amount of benefit upon the poor. 
But the question seems to be now, not whether we shall 
be enabled to enlarge our Dispensary, but whether we 
shall be able to keep it up on its present scale ? The 
amount of subscriptions this year is by no means credit- 
able to the large body of wealthy adherents to Homoeo- 
pathy over Scotland, for we have patients from all parts 
of the country ; and when it is recollected that more than 
twelve thousand patients have applied for relief since the 
Institution was opened, and that the annual expense is 
not above eighty pounds or so, ^ cannot help thinking 
that it would be a disgraceful exhibition of selfishness 
if the Institution were allowed to languish for want of 
proper support ; and it> would lead us to believe that 
the very handsome sums that poured in at the time of 
the cholera were wrung rather from the fears than the 
charity of those who gave them. 'This we know was 
not the case in many instances ; but unless the effi- 
ciency of the Institution be maintained now when the 
fear of the pestilence is gone, w r e cannot help ascribing 
a part of the apparent generosity to some such ignoble 
source. 

Before concluding, we would tender to Dr. Atkin of 



Xll PREFACE. 

Hull our acknowledgments for the assistance he has 
afforded us. When acting as House-Physician to the 
Dispensary, not only did he discharge all the duties 
required by his office in the most efficient manner pos- 
sible, but also prepared the valuable tables of which 
we have had occasion to make use in our work, be- 
sides giving us valuable aid in other parts of it. We 
would also thank Mr. Adie, our townsman, and distin- 
guished optician, for the weather tables which he kindly 
furnished ; and Mr. Alexander Bain, of the Board of 
Health, for his kindness and attention in giving us 
every information in his power which we required of 
him. 

We take this opportunity of informing all who are 
interested in it, that we are now collecting materials 
for a life of Hahnemann, and we should gratefully ac- 
cept any assistance from those who have either had 
the means of acquiring accurate information regarding 
him, or who could favour us with any of his letters. 

We shall not attempt any apology for the errors and 
omissions of this book, or the blemishes and inaccuracy 
in its composition, farther than that it was necessary, 
in order to make it of any use, to prepare it with the 
greatest possible speed, that it might be accessible 
before the cholera lighted upon the country ; and those 
who know what it is to write a book at the intervals of 
anxious business, and with the printing-press rattling 
at one's heels, will be the first to make due allowance 
for the imperfections of the present publication. 



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TO ILLUSTRATE A TREATISE ON EPEDEMIC CHOLERA 

BY 

J. RUTHERFURD RUSSELL M.D. 
18 4 9. 



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TREATISE ON EPIDEMIC CHOLERA. 



INTRODUCTORY CHAPTER. 

ON EPIDEMICS IN GENERAL. 

The appalling destruction of human life, caused by some of 
the pestilences in former ages, was so much the most strik- 
ing feature about them, that to it almost alone attention was 
directed. The history of the Plague of the 14th century was 
the narrative of death : the very name of the disease ex- 
presses this idea. It was called in one language " La Mor- 
talfege grande/' the great mortality ; in another, " Der 
schwarze Tod," the black death. And no wonder it should 
be so, when we read, " that in Cairo, from ten to fifteen thou- 
sand died in a single day, and that for many days succes- 
sively. In China, more than thirteen millions (nearly the 
population of England) are said to have died. India was de- 
populated. Tartary, the Tartar kingdom of Kaptschuk, 
Mesopotamia, Syria, Armenia, were covered with dead bodies. 
The Kurds fled in vain to the mountains. In Caramania and 
Csesarea none were left alive. On the roads, in the Camps, 



11 



Z INTRODUCTORY CHAPTER. 

in the Caravansaries, unburied bodies alone were seen/' 
" Cyprus lost almost all its inhabitants ; and ships without 
crews were often in the Mediterranean, as afterwards in the 
North Sea, driving about and spreading the Plague wherever 
they went/'* " It was reported to Pope Clement at Avignon, 
that, exclusive of China, twenty-three millions and upwards 
had fallen victims to the Plague throughout the East/' Sixty 
thousand died at Florence ; a hundred thousand at Venice ; 
a hundred thousand at London ; fifty thousand at Norwich. 
Many towns were bereft of their inhabitants. " When the 
Plague ceased, men thought they were still wandering among 
the dead, so appalling was the livid aspect of the survivors, 
in consequence of the anxiety they had undergone, and the 
unavoidable infection of the air/' Is it possible for us to 
realize the horrors of such scenes ? In ordinary times, death 
is the exception — life the rule ; all signs of death are imme- 
diately removed ; and although it is continually occurring, 
it is as quickly concealed. But when death becomes the 
rule, and life the exception, how inconceivably awful mijst 
be the feeling ! If solitary confinement deprive a man of 
reason, what must it be to be left the solitary tenant of a 
city or a ship ? The mind cannot take in the horror and 
loneliness of so frightful a condition. To be alive amid 
silence and corruption — surely the most agonizing form of 
death would be less terrible than to live in such a tomb. No 
wonder, we repeat, that those who looked on such plagues 
found nothing in them of any interest except the results. 
To us, however, who can calmly contemplate fatal epi- 

* This recalls to one's mind the scene of " the ancient mariner," and may 
have given the hint to the poet Campbell, who, in his picture of horrors which 
must environ the last of the race, " who shall creation's face behold, as Adam 
saw its prime," describes how 

ships were drifting with the dead, 

To shores where all was dumb. 



ON EPIDEMICS IN GENERAL. 3 

demies, their essential characteristic is not the number of 
their victims, which depends upon accidental circumstances. 
And it is of great importance that we should remember this ; 
for in turning from such descriptions of death to the recent 
or present epidemic of Cholera, in some parts of this coun- 
try, if the only interest were derived from the bills of 
mortality, it would immediately subside, when we found 
but a very trifling increase in the numbers on these tables, 
or perhaps no increase at all. Although in a life-insurance 
point of view, the cholera may be quite insignificant, yet 
as a member of the class of fatal epidemics, it is most 
interesting and important ; and who knows that it may 
not become invested with the more terrible interest of being 
a great mortality by becoming a general, instead of a partial 
disease ? The mortality of cholera is very great ; if it were 
as wide-spread as it is malignant, the result would be fright- 
ful. And we should bear in mind that we can do but little to 
prevent its diffusion, and indeed not much more to lessen its 
fatality. Thus we find this epidemic to be generically bound 
up with former ones ; and we believe it is only by inves- 
tigating what facts are common to all, that we shall arrive 
at a knowledge of the laws that regulate the occurrence and 
the course of each, and shall learn why they have so baffled 
all attempts to arrest their progress, and neutralize their 
destructive power. 

One of the most striking features of many former plagues 
is that they have not occurred without previous warning. 
They appear to have had their origin in the planet we dwell 
on ; and before their coming, the earth gave signs of some 
great internal disturbance. The pestilence which swept its 
surface, seemed the relief to those convulsions which shook 
its frame. Or taking a higher point of view, we may regard 
the wonderful succession of strange phenomena which pre- 



f^J^it^* 



4 INTRODUCTORY CHAPTER. 

cede a great destruction of human life, as so many indict- 
ments served upon our race by the Judge of the world, be- 
fore its guilty inhabitants are cited to His tribunal. May 
not the recurrence of such a judgment, in an age like ours, 
when by the wonderful triumphs of scientific perseverance, 
man seems to have got the better of the earth altogether, 
and spreading it over with a tissue of rails and wires, as with 
a system for circulation and nervous communication, to have 
fashioned it into an obedient organism over which he pre- 
sides, be a reassertion of the often repeated and as often for- 
gotten fact, that " the earth is the Lord's, and they that dwell 
thereon V If it be superstition which has led man in all 
former ages to associate the signs in the sky with the great 
events among the nations of the earth, in the instance of 
plagues at least it is a very reasonable belief, fully borne out 
by the history of the times. After a general observation to 
the effect that " the black death" was preceded by unusual 
terrestrial convulsions,* Hecker continues : — " The series of 
these .great events began in the year 1333, fifteen years be- 
fore the Plague broke out in Europe. They first appeared 
in China. Here a parching drought, accompanied by famine, 
commenced in the tract of country watered by the rivers 
Kiang and Hoai. This was followed by such violent tor- 
rents of fain in and about Kingsai, at that time the capital 
of the empire, that, according to tradition, more than four 
hundred thousand people perished in the floods. Finally, 
the mountain Tsincheou fell in, and vast clefts were formed 
in the earth. In the succeeding year (1334) passing over 
fabulous traditions, the neighbourhood of Canton was visited 
by inundations ; whilst in Tche, after an unexampled 
drought, a plague arose which is said to have carried off five 

* The Epidemics of the Middle Ages, by J. F. C. Hecker. M.D. Translated by 
B. S. Babington, M.D., F.R.S. London, 1844. 



ON EPIDEMICS IN GENERAL. 5 

millions of people. A few months afterwards, an earthquake 
followed, at and near Kingsai ; and subsequently to the fall- 
ing in of the mountain of Ki-ming-chan, a lake was formed 
of more than a hundred leagues in circumference, where again 
thousands found their grave. In Houkouang and Ho-nan, 
a drought prevailed for five months ; and innumerable 
swarms of locusts destroyed the vegetation ; while famine 
and pestilence, as usual, followed in their train. Connected 
accounts of the condition of Europe before this great cata- 
strophe are not to be expected from the writers of the four- 
teenth century. It is remarkable, however, that simultane- 
ously with a drought and renewed floods in China in 1336, 
many uncommon atmospheric phenomena occurred, stnd in 
the winter, frequent thunderstorms were observed in the 
north of France ; and so early as the eventful year of 1333, 
an eruption of Etna took place. According to the Chinese 
annals, about four millions of people perished of famine in 
the neighbourhood of Kiang in 1337 ; and deluges, swarms 
of locusts, and an earthquake which lasted six days, caused 
incredible devastation. 

" The signs of terrestrial commotion commenced in Europe 
in the year 1348, after the intervening districts of country 
in Asia had probably been visited in the same manner. 

" On the island of Cyprus the plague from the East had 
already broken out ; when the earthquake shook the founda- 
tions of the island, and was accompanied by so frightful a 
hurricane that the inhabitants, who had slain their Maho- 
metan slaves in order that they might not themselves be 
subjugated by them, fled in dismay in all directions. The 
sea overflowed, the ships were dashed to pieces on the rocks, 
and few outlived the terrific event, whereby the fertile and 
blooming island was converted into a desert. Before the 
earthquake a pestiferous wind spread so poisonous an odour 



6 % INTRODUCTORY CHAPTER. 

that many overpowered by it, fell down suddenly and expired 
in dreadful agonies. * * * 

" Pursuing the course of these grand revolutions further, 
we find notice of an unexampled earthquake which, on the 
25th of January 1348, shook Greece, Italy, and the neigh- 
bouring countries. Naples, Rome, Pisa, Bologna, Padua, 
Venice, and many other cities suffered considerably : whole 
villages were swallowed up — castles, houses, and churches 
were overthrown, and hundreds of people were buried be- 
neath their ruins. In Carinthia thirty villages, together 
with all the churches, were demolished ; more than a thou- 
sand corpses were drawn out of the rubbish ; the city of 
Villach was so completely destroyed that very few of its 
inhabitants were saved ; and when the earth ceased to trem- 
ble it was found that mountains had been removed from 
their position and many hamlets were left in ruins. 

" More destructive earthquakes extended as far as the 
neighbourhood of Basle, and recurred until the year 1360 
throughout Germany, France, Silesia, Poland, England, and 
Denmark, and much farther north. 

" Great and extraordinary meteors appeared in many 
places, and were regarded with superstitious horror. A 
pillar of fire which, on the 20th of December 1348, remained 
for an hour at sunrise over the Pope's palace at Avignon ; 
a fireball which in August of the same year was seen at 
sunset over Paris, and was distinguished from similar pheno- 
mena by its longer duration, not to mention other instances, 
mixed up with wonderful prophecies and omens, are recorded 
in the chronicles of that age. 

" The progress of connected natural phenomena from east 
to west — that great law of nature — is plainly revealed, which 
has so often and evidently manifested itself in the earth's 
organism, as well as in the state of nations dependent upon 



ON EPIDEMICS IN GENERAL. 7 

it. In the inmost depths of the globe that impulse was 
given in the year 1333, which in uninterrupted succession 
for six and twenty years shook the surface of the earth, even 
to the western shores of Europe. From the very beginning 
the air partook of the terrestrial concussion, atmospheric 
waters overflowed the land, or its plants and animals per- 
ished under the scorching heat. The insect tribe was won- 
derfully called into life, as if animated beings were destined 
to complete the destruction which astral and telluric powers 
had begun. Thus did this dreadful work of nature advance 
from year to year: it was a progressive infection of the 
zones, which exerted a powerful influence both above and 
beneath the surface of the earth/' 

We have quoted the above passages at considerable length 
to bring distinctly into view two important facts. The first 
is, that fatal epidemics which affect the inhabitants of the 
earth generally are in some way or other connected with 
telluric phenomena, and that their course is in a given direc- 
tion, from east to west. In the words of a French author on 
the subject : — " Le grand mouvement des phenomfenes phy- 
siques de Tunivers se fait d'orient en Occident, tel que celui 
de la lune et des autres constellations, ainsi que du flux et 
reflux de la mer, tandis que la terre seule opfcre sa revolu- 
tion en sens contraire. 

" Le genre humain a pris naissance en orient ; il s'est 
propage de Test a Touest, des rives de TEuphrate a Focean 
occidental : ainsi les premiers enfants de la terre peupl&rent 
Tlnde, TAfrique, le sud-est de TEurope. Dans la suite les 
Scythes et les Tartares franchirent les monts Ourals et le 
Caucase pour venir habiter la Russie, la Turquie, et les 
bords de la mer noire et les grands fleuves de TEurope. De- 
la sortirent les Huns, les Lombards, les Alains, les Vandales, 
les Su&ves, les Germains, les Galles, les Goths, les Visigoths, 



8 INTRODUCTORY CHAPTER, 

les Bourguignons qui s'etablirent le long du Danube, du 
Rhin, et de la mer du nord. Dela comme un torrent deborde 
et impetueux ils s'elanckrent dans les Gaules et liberie. 
Plus-tard, les Maures vinrent aussi de Torient s'etablir dans 
cette derniere contree, tandis que les Normands envahissaient 
la Gaule occidentale, et les Saxons la Grande Bretagne. On 
voit encore de nos jours des peuplades partant de Test de 
VEurope pour aller fonder des colonies en Amerique. Enfin 
toutes les irruptions des Barbares ont eu lieu dans la direction 
de Torient a Toccident. 

" La merae direction s'observe a Tegard des epidemies, 
ainsi la Peste, la Variole, la Rougeole, la Lepre nous furent 
apportees de la Turquie, et de la Syrie, par les Maures et 
les Juifs chasses par les Califes et les Croises. La peste 
noire du 14me si&cle prit naissance au Katai en Chine, et 
vint terminer ses ravages et son existence sur les rivages de 
Tocean. Les epidemies catarrhales de 1239, 1311, 1323, 
1400, 1427, 1557, 1580, et plusieurs autres qu'on appelle 
la Russe, la Muscovite, Tlnfluenza, la Dando, la Coquette, 
&c, sont toutes venues du nord-est de 1'Europe et ont ex- 
pirees sur les bords de TOcean Atlantique. Le Typhus est 
venu de la Hongrie, au 16me sifecle, on Tappela fi&vre Hon- 
groise, enfin le Cholera nous est arrive des extremites orien- 
tates de la Chine et de Tlnde. Nous pourrions citer aussi 
de nombreuses epizooties et notamment celle de 1814 qui 
ont suivi la meme direction/'* 

If we had any means of ascertaining the natural succession 
of these phenomena, it would be an interesting addition to 
our knowledge ; but there are insurmountable difficulties in 
doing so with regard to occurrences spread over so vast a tract 
of the earth, and of which such imperfect accounts are pre- 
served. The second act may have commenced at one place be- 

* Histoire Mod. dca Maladies Epidtfm. Par J. A. F. Ozanara. Vol. ii. p 254. 



ON EPIDEMICS IN GENERAL. 9 

fore the first is finished at another no great distance off ; and 
in the narrative of the occurrences two or more may have been 
blended, and thus at the outset create inextricable confusion. 
The only instance in ancient and strictly authentic his- 
tory where we have a series of such occurrences may be 
considered by many as altogether out of the pale of scientific 
investigation, belonging to the ^rafernatural, not to the 
natural order of events. We refer to the Plagues of Egypt, 
described by Moses. To prevent misunderstanding, we are 
anxious to begin by saying, that supposing the phenomena 
in question to be strictly in accordance with natural laws, 
this does not at all imply that they are not also miraculous. 
The meaning of a miracle is not to introduce a new power 
disconnected with the ordinary operations of nature, and so 
tending rather to strengthen than to uproot the mischievous 
error of regarding these operations as resting on something 
else than the constant Divine Will. It is rather by a start- 
ling and unusual exhibition of the same power by which all 
things consist from day to day, to recall the attention of 
those who are thus emphatically addressed to the fact that 
all these agencies, (in the particular sphere of the miracle,) 
are under the immediate command of a supreme moral Go- 
vernor, at whose bidding they utter these strange voices. To 
effect this object it is not necessary that any known laws 
of nature be suspended, far less violated ; it is enough that 
the events be such as cannot at the time be referred to any 
known sequences, on account of their nature, their intensity, 
or their concentration, as it were, into one point, and that 
point indicating a great moral purpose.* The miracle will be 

* The miracle is not a greater manifestation of God's power than those ordi- 
nary and ever repeated processes (by which nature is sustained); but it is a 
different manifestation. I3y those other God is speaking at all times, and to 
all the world ; they are a vast revelation of Him. " The invisible things of 
Him are clearly seen, being understood by the things that are made, even His 



10 INTRODUCTORY CHAPTER. 

much more obvious, if the event be foretold with a minute- 
ness of detail far beyond the powers of science to attempt, and 
its moral purpose be at the same time expressly announced. 
Without such announcement it may be unintelligible. Had 
Moses not spoken to Pharaoh, and proclaimed beforehand the 
definite object to be served by the terrible catastrophes which 
were so soon to follow, the tyrant, though terrified — " for 
conscience doth make cowards of us all" — might have been 
as much at a loss to account for the dreadful scenes he wit- 
nessed as we may suppose the Pope to have been when he 
saw a pillar of fire resting over his palace at Avignon. 

We make these observations on the assumption that the 
succession of terrific phenomena rising step by step to the 
climax of the destruction of the people of Jigypt, by means 
of which the children of Israel were set free, are capable of 
explanation by natural laws, and therefore, besides convey- 
ing, as they always must to the devout mind, one of the 
most emphatic moral lessons on record, may also be a proper 
object of scientific reference. 

In the observations on the plagues of Egypt which we are 
about to make, we have taken Hengstenberg* for our guide ; 

eternal power and Godhead." (Rom. i. 20.) Yet from the very circumstance 
that nature is thus speaking unto all — that this speaking is diffused over all 
time, addressed unto all men — from the very vastness and universality of this 
language it may miss its aim. It cannot be said to stand in nearer relation to 
one man than to another — to confirm one man's word more than that of others 
— to address one man's conscience more than that of every other man. However 
it may sometimes have, it must often lack a peculiar and personal significance. 
But in the miracle wrought in the sight of some certain men, and claiming their 
special attention, there is a speaking to them in particular. There is then a 
voice in nature which addresses itself directly to them — a singling them out 
from the crowd. It is plain that God has now a peculiar word, which they are to 
give heed to — a message to which he is bidding them listen. — Notes on the Mira- 
cles of our Lord. By Richard Chevenix Trench, M.A., Professor of Divinity, 
King's College, London, &c. &c p. 11. 

* Egypt and the Books of Moses. By Dr. E. W. Hengstenberg, Professor of 
Theology at Berlin. Translated by R. D. C. Robins. American edition. 



ON EPIDEMICS IN GENERAL. 11 

and all Biblical students are aware that in his name they 
have the best security both for the learning and soundness 
of the interpretation of Scripture. 

To have a clear idea of the occurrences described in the 
beginning of Exodus, we require to determine the relative 
locality of the Israelites and Egyptians, and also the time of 
year of the events. The land of Goshen seems to have been 
the region east of the Tanitic arm of the Nile, as far as the 
Isthmus of Suez, on the border of the Arabian desert. It 
was therefore a border country, out-lying, not surrounded by 
other Egyptian territory. The ten plagues must have occur- 
red between the month of July and the following month of 
April. 

The absence of contemporary history prevents our know- 
ing whether they were confined to Egypt, or extended oyer 
a larger portion of the earth. It is probable that some re- 
markable meteorological phenomena had occurred at the 
source of the Nile, or, at all events, high up the river. But 
whether these supposed phenomena were attended by a pes- 
tilence or not, we have no means of ascertaining. 

The first four plagues seem all to have arisen from a com- 
mon cause — an extraordinary inundation of the Nile. The 
expression that the waters were turned into blood means 
that they looked like blood, and were unfit for use : as 
when Joel says — " the sun shall be turned into darkness, 
and the moon into blood," — that is, shall have the colour and 
appearance of blood. Generally speaking, the Nile water is 
excellent for drinking ; but in seasons of great heat, when 
the river has been unusually low, on its first rising it is quite 
discoloured, and undrinkable. Thus, "in the year 1199 the 
increase of the Nile was smaller than it had ever been 
known. About two months before the first indications of 
the inundation, the waters of the river assumed a green 



12 INTRODUCTORY CHAPTER. 

colour ; this increased by degrees, and it became putrid and 
offensive to the taste ; sick persons avoided drinking from 
it, and drank well-water. By boiling, its smell and taste be- 
came worse. There also appeared in it worms and other 
animals which live in stagnant water/' (In De Sacy, on 
Abdollaliph, p. 332.) Again, in 1673, the Nile reddened in 
July, and continued so till December. (Ik p. 346.) The 
plague consisted in the excessive degree of reddening and 
putridity. The ordinary amount of impurity was removed 
by putting the water into vessels of wood and stone, whereby 
a deposit took place, and the water above became clear ; but 
in this instance it remained red and blood-like in all the 
vessels of the Egyptians. 

The second plague — that of the frogs — is simply a greatly 
increased number of those animals, which, by all accounts, 
are generally abundant enough in Egypt. In some parts of 
Italy we have seen frogs in such swarms on the dry ground 
that it was almost impossible to set down the foot without 
crushing some of them. " In the summer of 1831, 1 often ob- 
served immense flocks, if I may use the term, of young toads 
in the vicinity of Sunderland, which I pointed out to several 
of my friends/'* . 

The expression used to describe the third plague is pro- 
perly translated gnats. All travellers speak of gnats as an 
ordinary plague of the country. They pursue the men, pre- 
vent their eating, disturb sleep, and cause swellings which are 
very painful. They are most abundant after the rice harvest, 
that is, at the end of the inundation of the Nile, and would 
naturally be increased by an excessive extent of flooded land. 
The fourth plague was that of the flies. These, too, torment 
the inhabitants of Egypt even yet to a great extent. One 
traveller says : " The most numerous and troublesome insects 

* The Cholera of Sunderland, by W. Reid Clanny. 



ON EPIDEMICS IN GENERAL. 13 

in Egypt are flies. Men and animals are grievously tormented 
by them. It is impossible to form an adequate conception 
of their fury when they wish to fix themselves on any part 
of the body. If they are driven away, they light again the 
same instant, and their pertinacity wearies the most patient/' 

We class these first four plagues together, because they 
are of a local character — being peculiar to the climate and 
geographical conditions of Egypt. However, we may notice 
in passing, that a great increase of insect life has frequently 
been observed to attend or precede many epidemics, and, 
among others, the cholera. So that perhaps we may legiti- 
mately include the inundation of frogs, gnats, and flies in 
the proper series of antecedents of the subsequent great 
mortality, although the nature of the soil of Egypt gave it 
what we may call a predisposition to suffer from them to an 
unusual degree, and that they should be of an unusual kind. 

The fifth plague was the destruction of cattle by a mur- 
rain. Before an epidemic, it is not uncommon to have a 
disease among the lower animals. A most deadly distemper 
prevailed among the cattle in this country during the years 
1846-47. Whether we have a right to regard the potato 
disease as the first indication of the approach of an epidemic, 
is certainly a curious question — as if beneath the first wave 
of noxious influence, there drooped the most sensitive of 
the vegetable kingdom, under the second there fell the 
cattle, and under the third man — the disease in each case 
being conditioned by its subject. 

The sixth plague — that of boils — was probably some pain- 
ful but not deadly cutaneous eruption. We have an exam- 
ple of a mild epidemic preceding a deadly one in the influ- 
enza of 1847. A succession of epidemics increasing in 
severity has also been noticed. Thus in the years 1 733, 
1738, and 1743, there raged a succession of epidemics quite 



14 INTRODUCTORY CHAPTER. 

different from one another. They extended over both the 
Old and New World, and are called by French writers La 
Grippe, La Folette, and La Russe.* 

The seventh plague was a tempest. We have before had 
occasion to notice the fact, that atmospheric commotions, 
attended with electrical phenomena, have in almost all in- 
stances been observed to usher in a great pestilence. In 
lower Egypt, tempests attended with hail and thunder are 
not uncommon. 

The eighth plague was the locusts. We have already ad- 
verted to the increase of insect life when epidemics prevail. 
In the instance now under consideration, they seem to have 
been brought in unusual numbers by an east wind, and car- 
ried off again by a west wind, which was of a very peculiar 
kind, known at present by the name " ehamsin." 

The darkness which overshadowed all the land of Egypt, 
probably arose from the blowing of this "chamsin" with 
great violence, attended perhaps with some electrical pheno- 
mena, as in the instance thus described by an eye-witness : — 
" The sun, without being veiled with clouds, had been 
shorn of its beams ; it gave only a white and colourless light 
more feeble than the moon. A reddish dusky appearance 
filled the region. With wounded eyes and nose so filled that 
we could scarcely breathe, we strayed from one another, lost 
our way, and found our dwellings with great difficulty, feel- 
ing along by the walls. On the following morning, the same 
cloud of dust was driven in like circumstances along the 
Lybian desert. It followed the mountain range ; and when 
we believed ourselves free from it, the west wind turned it 
back. Lightnings shot feebly through these dark clouds ; 
all the elements appeared to be in commotion; the rain 
mingled with the lightning gleams, with wind and dust ; 

* Ozanam, Hist. M6d. des Malad. Epid. p. 87. 



ON EPIDEMICS IN GENERAL. 15 

everything seemed returning to chaos and old night."* An 
old chronicle of the eleventh century records : — " There oc- 
curred a great and violent storm, accompanied by darkness* 
Edifices were destroyed and houses demolished ; moreover, 
Egypt was covered with so thick a darkness, that all believed 
the Resurrection had come/' 

In speaking of the year 1760, in which the plague broke 
out at Aleppo, Russell says : — " It may be added that the 
present period had been preceded by famine, by uncommon 
diseases, and by earthquakes ; a comet had been observed in 
the spring of 1759, and in the present year an eclipse of 
the sun — all which portentous events have ever, in the East, 
been considered as forerunners of a pestilence/' 

The following extract is taken from the Times newspaper 
of the 5th of May of this year, and the very curious pheno- 
mena described were coincident with a new outbreak of 
epidemic cholera : — " We make the following extract from a 
report of the proceedings of the Royal Dublin Society in a 
late number of the Dublin Freeman s Journal : — ' Pro- 
fessor Barker presented to the notice of the Society a bottle 
containing a portion of black rain which had been transmit- 
ted to him from Carlow, with a view to satisfy the scruples 
of many persons who appeared to doubt that rain of this de- 
scription had fallen. He had received communications on 
the subject from persons residing in several of the districts 
in which the rain had descended, and he was in a position 
to state, not only that such rain had actually fallen, but to 
mention the space of country over which it had been dif- 
fused. The specimen which he presented to the Society 
had been sent to him from Carlow, accompanied by a letter, 
in which the writer mentioned that at the time of its collec- 
tion it was uniformly black, and resembled ordinary writing 

* Denon, vol. i. p. 285. 



16 INTRODUCTORY CHAPTER, 

ink ; but lie (Dr. Barker) found that after allowing it to 
stand for a short period, the black colouring matter separated 
from the water with which it had been mixed, rendering the 
colour of the rain much lighter than at first. The places in 
which this phenomenon occurred were Abbeyleix, Carlow, 
Kilkenny, and Athy, from which it would appear that the 
black shower had extended over an area of more than 400 
square miles. As far as he had been able to ascertain, it 
occurred about six o'clock in the evening of the \4<th instant, 
being preceded by such extreme darkness that it was impos- 
sible to read except by candle-light After this darkness had 
existed for some time, a hail-storm, attended with vivid 
lightning, but without thunder, occurred, and when this 
subsided, the black rain fell. It was mentioned by his Car- 
low correspondent, that upon examining a quantity of this 
rain just after it had fallen, he found it had an extremely 
foetid smell, and a very disagreeable taste ; that it had left 
a stain upon some clothes on which it had fallen, and that 
cattle refused to drink it. At Abbeyleix and Athy, where 
the shower descended at the same moment, the appearance 
of the rain was precisely similar to that which fell in Car- 
low, but it was unaccompanied by the lightning which had 
been observed at the latter place. Dr. Barker then stated 
that as yet he had not been enabled to make a complete 
chemical analysis of the rain/ " 

With reference to the tenth plague, which interests us most 
at present, we may quote the following observations from 
Hengstenberg : — "It may be proper to remark here, before we 
proceed with the tenth plague, that the phrase ' all the first- 
born/ must not be pressed too far. The whole tenor of the 
narrative is opposed to such a proceeding, and particularly 
the declaration, c there was no house where there was not 
one dead/ since in every house there was not a first-born. 



ON EPIDEMICS IN GENERAL. 17 

" If we take into view the time in which the last plague 
occurs, we cannot deny that we find something analogous to 
it in a pestilence described by MinotolL It is not material 
whether it be allowed that the plague raged at so early a 
period, or that another similarly destructive disease existed 
in its place. The plague, he says, commonly makes its ap- 
pearance at Cairo about the end of March or the beginning 
of April. The miasma is communicated merely by contact. 
Local causes, however, increase its malignancy ; and even the 
prevailing winds have an important influence. With an un- 
interrupted chamsin, the plague increases frightfully, and 
speedily takes off those who are attacked by it. 

" Compare also the ' description/ where, in accounting for 
the sickness, it is imputed mainly to the chamsin ; and it is 
remarked, that great inundations, which leave numerous 
morasses, always precede destructive epidemics." 

The sparing of the Israelites, wonderful as it undoubtedly 
was, is not without analogy. For example, in 1827, the in- 
habitants of Gooty suffered severely from the cholera ; while 
the regiment which was there, and furnished guards to the 
town, enjoyed perfect health. On a sudden this was reversed ; 
the soldiers were attacked, and the townspeople escaped.* 
And Cardem, in speaking of the plague at Basle, says, that 
it attacked only the Swiss, and spared the Germans, French, 
and Italians who lived in the town.-(- In the recent occur- 
rence of the cholera at Tooting, the children were the only 
sufferers ; probably, however, in this case from improper ali- 
ment and other reasons, which do not apply to the other in- 
stances of the same kind. There are several similar examples- 
on record. 

We may thus perhaps conclude that in the earliest of hu- 

* Treatise on the Epidemic Cholera, by A. T. Christie, M.D. 1803. P. 15. 
f Ozanam, Hist. M6d. des Malad. Epid. Vol. i. p. 77. 

B 



18 INTRODUCTORY CHAPTER. 

man records, coeval with the Pyramids, there is preserved an 
epitome of the future history of great epidemics, which de- 
vastated nearly the whole earth ; and so far from divesting 
the wonders in the land of Egypt of their Divine significance 
and strictly miraculous character, it seems to us that by view- 
ing these successive events as produced by the ordinary laws 
of nature, and converted into direct judgments by having been 
predicted and interpreted, and considering them as the type 
of all future pestilences, we shall see in these, too, a work of 
judgment and of mercy, not the less significant because there 
is now no prophet to foretell their approach and warn us of 
the particular offences they are meant to chastise, and no 
inspired historian to give the true meaning, as well as the 
faithful picture of the calamity. And possibly a more 
thoughtful consideration of the matter might bring us back 
to the mind of an elder age, when the moral laws of the 
universe were recognised as the true basis of the physical, 
and man's wellbeing and immunity from distress and mi- 
sery were not rested on his obedience to the laws of this 
world alone. As in the time of Pharaoh, submission to the 
Word of the Lord was the only escape from the pesti- 
lence ; so in all future ages obedience to His Will, in its 
fullest sense, by all mankind, were it possible, could alone 
avert, by making unnecessary, those fatal, ever new epi- 
demics which have so often scourged our race. In the 
words of the venerable Ambrose Pare on " Le vray et Sou- 
uerain remede contre la peste." " Et d'autant plus que ce 
mal est grand, d'autant faut il recourir promptement au 
remede qui est seul et general : c'est que grands et petits de 
bonne heure implorions la misericorde de Dieu par confession 
et desplaisance de nos forfaicts, auec certaine deliberation et 
propos de nous amender et donner gloire au nom de Dieu, 
cherchant en tout et par tout de luy obeyr et complaire 



ON EPIDEMICS IN GENERAL. 1 9 

suiuant la saincte parole sans estriuer a rencontre de luy par 
nos desordonees passions comme nous auons fait et faisons 
iournellement/'* 

There is one other curious circumstance connected with 
great epidemics to which we must briefly advert before leaving 
the general consideration of the subject, and it is the strange 
and powerful effect they have or had upon the minds of men. 
Scarcely had " the black death" subsided, when a delusion of 
the most extraordinary kind began to prevail. It was called 
the Dance of St. Vitus, and consisted in the performance of 
a succession of dreadful contortions of the body, attended 
with screaming and foaming at the mouth. It spread like 
a demoniacal possession over a great part of Europe. Instead 
of genuine devotion, the proper effect of a great calamity, we 
have its most hideous counterfeit, in an abandoned and most 
revolting superstition. It lasted for many years, and never 
since has reappeared as a general epidemic ; although it has 
frequently prevailed in limited districts of this and other 
countries, and even yet it is not altogether extinct, occurring 
every now and then in the sporadic form. 

How far the cause of such strange phenomena is moral, 
and how far purely physical, is an insoluble problem at pre- 
sent. We know that certain natures are very powerfully 
impressed by telluric influences,^ and we have seen that 

* Les (Euvres d'Ambroise Pare\ &c, &c, p. 569. Lyons, 1641. 

f We may give as an instance the following anecdote of Goethe, told by Ecker- 
raann : — 

" Thursday, Nov. 13, 1823. 

" Some days ago, as I was walking one fine afternoon towards Erfurt, I was 
joined by an elderly man, whom I supposed, from his appearance, to be some 
respectable citizen. We had not been long together before the conversation 
turned upon Goethe. On my asking whether he knew Goethe — ' Do I know 
him?' said he with vivacity; * I was his valet almost twenty years !' I begged 
to hear something of Goethe's youth, and he gladly consented to gratify me. 

" ' When I first lived with him,' said he, * he was very active in his habits, 
thin and elegant in his person. I could easily have carried him in my arms/ 



20 INTRODUCTORY CHAPTER. 

great epidemics were naturally preceded or attended by dis- 
turbances both of the earth and the sky. We may observe, 
in passing, that the Egyptian magicians who withstood 
Moses, were evidently believers in their own power to effect 
all he did. Egypt is still the land of magic ; and to this day 
the traveller sees many strange sights which he can neither 
explain nor discredit. If some of these find their explana- 
tion in mesmeric phenomena, we may well believe that the 
subject of this mysterious influence is always strongly acted 
upon by the powers of the air. 

I asked whether Goethe, in that early part of his life here, was disposed to 
gaiety. ( Certainly,' he replied, ' always gay with the gay, but never when 
they passed a certain limit ; in that case, he became grave. Always working 
and seeking ; his mind always bent on art and science ; that was the way with 
my master. The Duke often visited him in the evening ; and staid so late, con- 
versing on literary topics, that I would get extremely tired, and long to have 
the Duke go away. One time he rang for me in the middle of the night. When 
I came up, I found he had rolled his iron trundle-bed to the window, and was 
lying there looking out upon the heavens. ' Have you seen nothing remark- 
able in the heavens ?' asked he ; and when I answered in the negative, bid me 
run to ask the same question of the watchman. He said he had not seen any- 
thing remarkable. When I returned with this answer to my master, I found 
him in the same position in which I had left him — lying in his bed, and gazing 
upon the sky. ' Listen,' said he to me, ' this is an important moment ; there is 
now an earthquake, or one is just going to take place ;' then he made me sit 
down on the bed, and showed me by what signs he knew this. 

" I asked the good old man what sort of weather it was. 

" ' A cloudy night,' he replied, * no air stirring ; very still and sultry.' I asked 
if he believed there was an earthquake merely on Goethe's word ? 

" ' Yes,' said he, k I believed it, for I always found things happened as he said 
they would. Next day, while he was relating his observations at Court, a lady 
whispered to her neighbour, * What visions are these of Goethe's V But the 
Duke, and all the men present believed Goethe ; and the correctness of his ob- 
servations was confirmed in a few weeks, by the news that a part of Messina 
was on that night ruined by an earthquake." — EckermamVs " Conversations 
with Goethe in the Last Years of his Life." Translated by S. M. Fuller. Pp. 
64-66. Boston, 1839. 



ON EPIDEMIC CHOLERA. 



CHAPTER I. 

ITS MARCH. 

India and some parts of China seem to have been the 
birthplace and home of cholera from the earliest ages ; but 
until 1817, we cannot -affirm with certainty that it ever as- 
sumed an epidemic character, or spread over other parts of 
the world. It has indeed been supposed that the plague 
which consumed the Israelites in David's time was this dis- 
ease, and the following description quoted from Josephus 
by Christie may perhaps justify the inference : — " The pro- 
phet had no sooner received and reported David's answers, 
but the Israelites were seized with a most unaccountable 
distemper, that was still attended with certain death, and 
accompanied with accidents that baffled all the doctors 
either to find a remedy or reason; but they died, in short, 
one upon the neck of another, no one knew how. Some went 
off with gripes and torments that despatched them in a trice ; 
some with incurable faintness and languors, in despite of the 
physicians ; others with vertigo, dimness of sight, suffocations, 



22 ON EPIDEMIC CHOLERA. 

&c. The mortality was so great, in fine, that between break 
of day and dinner-time there were swept away by this pesti- 
lence seventy thousand persons.* 

It is said to have ravaged Europe in 1600 ; and Ozanam 
gives the following quotation from Zacutus de Lisbonne, — 
" Anno 1600, quando hsec pestifera lues Europam fere 
totam oppresserat, observavi plures qui hoc diro dolore af- 
fecti venenosis symptomatibus excruciati, occubu^re omnes ; 
nullus quartum diem pertransit. * * * 

" Materia semicruda cum ichoribus multis ubertim qui 
per alvum et vomitum protrudit et multoties in tanta co^pia, 
ut ob exhaustum spiritum superveniant syncope, animi de- 
liquia, virium jactura, pulsus ablati, intensissima sitis, con- 
vulsio, rigor, nervorum retractiones, aphonia, stupor, caligo 
oculorum, extremorum frigiditas, anxietas, angor, facies 
hippocratica et mors/' (De Prax. Admirand. lib. ii. obs. 23 
and xv.) 

But at best these are but dim notices — more interesting 
to the antiquarian than to the practitioner ; and we pass to 
clearer descriptions by writers of the present day. 

In casting one's eye upon the map of India, it is impossible 
not to be struck with the watering of the great plain of the 
Ganges. Not only does the main trunk ramify on both 
sides as we track it upward towards its source, but instead of 
debouching by one large outlet, like rivers confined by bar- 
riers as in our own country, it splits into many fingers, as it 
were — each of which finds its own separate entrance into 
the sea. There are few plains in the world watered like the 
Delta of the Ganges. Here it was that in the summer and 
autumn of 1817, cholera burst out in various places simulta- 
neously, destroying six thousand of the inhabitants of the 
town of Jessore, about eighty miles north-east from Cal- 

* The Works of Flavius Josephus, by Sir Thomas l'Estrange. London, 1702. 



ITS MARCH. 23 

cutta ; and in a few weeks stretching from Sylhet on the 
east, to the extreme borders of Balasore and Cuttack, and 
reaching from the mouths of the Ganges, nearly as high as 
its junction with the Jumna. At this period, within an area 
of several thousand miles, scarcely a town or village escaped ; 
and so great was the mortality, that the bulk of the whole 
population was sensibly diminished. The large and popu- 
lous city of Moorshedabad, however, situated in the heart of 
the conflagration, almost entirely escaped. It hardly crossed 
the Ganges — appearing on the eastern side like an exotic, 
which soon dies out 

Towards the end of autumn, instead of bursting out over 
the country as it had done, it began to travel in a given 
direction, and to confine itself within certain geographical 
boundaries ; and in its march, it encountered, for the first 
time, in the beginning of November 1817, the centre division 
of the British army, under the command of the Marquis of 
Hastings, near the banks of the Sinde : " It was here/' 
says Mr. Jamieson, in the c Bengal Report/ " that the dis- 
ease first put forth all its strength, and assumed its most 
deadly and appalling form. It is uncertain whether it made 
its approaches on the 6th, the 7th, or the 8th of the month. 
After creeping about, however, in its wonted insidious man- 
ner for several days among the lower class of the camp-fol- 
lowers, it as it were in an instant gained fresh vigour, and 
at once burst forth with irresistible violence in every direc- 
tion. Unsubjected to the laws of contact and proximity of 
situation, which had been observed to mark and retard the 
course of other pestilences, it surpassed the plague in the 
width of its range, and outstripped the most fatal diseases 
hitherto known in the destructive rapidity of its progress. 
Previously to the 14th, it had overspread every part of the 
camp, sparing neither sex nor age in the undistinguishing 



24 ON EPIDEMIC CHOLERA. 

virulence of its attacks: the old and the young, the Euro- 
pean and the native, fighting-men and camp-followers, were 
alike subject to its visits, and all equally sunk in a few 
hours under its powerful grasp. From the 14th to the 20th 
or 22d, the mortality had become so general as to depress 
the stoutest spirits ; the sick were already so numerous, and 
still pouring in so quickly from every quarter, that the 
medical men were no longer able to minister to their neces- 
sities. The whole camp then put on the appearance of an 
hospital. The noise and bustle, almost inseparable from the 
intercourse of large bodies of people, had nearly subsided ; 
nothing was to be seen but individuals anxiously hurrying 
from one division of the camp to another to inquire after 
the fate of their dead or dying companions, and melancholy 
groups of natives, bearing biers of their departed relatives 
to the river. At length even this consolation was denied 
them ; for the mortality latterly became so great that there 
was neither time nor hands to carry off the bodies, which 
were then thrown into the ravines, or hastily committed to 
the earth in the sheets in which they had expired, and even 
round the walls of the officers' tents. All business had 
given way to solicitude for the suffering. Not a smile could 
be discovered, not a sound heard, except the groans of the 
dying, and the wailing over the dead. Throughout the night 
especially a gloomy silence, interrupted only by the well- 
known dreadful sounds of poor wretches labouring under the 
distinguishing symptoms of the disease, universally prevailed. 
The natives, thinking that their only safety lay in flight, 
had now begun to desert in great numbers, and the high- 
ways and fields, for many miles round, were strewed with 
the bodies of those who had left the camp with the disease 
upon them, and speedily sunk under its exhausting effects." 
The army was moved on the 13th ; and on the 1 9th encamped 



ITS MARCH. 25 

on high and dry ground at Erich, where the pestilence soon 
entirely disappeared. The whole line of march presented a 
most deplorable spectacle ; hundreds dropped down on the 
road, which looked like a field of battle, or the track of a 
defeated army. " The exact amount of mortality during 
these few calamitous days could not, from the circumstances 
of confusion and general disorder under which it took place, 
be ascertained with any degree of accuracy. From the 
military returns, however, it appears that in this fatal 
week, of 11,500 fighting men of all descriptions, 764 fell 
victims to the disorder ; and of the camp-followers, it was 
conjectured that 8000, or one-tenth of the whole, were cut 

off." 

This great mortality in our army naturally reminds one 

of the still more terrible destruction that overtook the 
Assyrians in the time of King Hezekiah. " And it came 
to pass that night, that the angel of the Lord went out 
and smote in the camp of the Assyrians an hundred and 
fourscore and five thousand ; and when they arose early in 
the morning, behold they were all dead corpses/' (2 Kings 
xix. 35.) 

In the year 1818, the cholera advanced in a westerly di- 
rection as far as Kotah, a town situated on the eastern side 
of a range of high hills, which, as will be seen by casting a 
glance at the map, form the western boundary of the basin of 
the Ganges. Here it stopped ; and there were no cases in 
Odneypoor or Ajmeer, which are the first considerable towns 
on the other side of the mountain range. The inhabitants 
of the country on this side congratulated themselves on having 
escaped the enemy, which had taken full possession of the 
whole of the valley beyond their rocky barrier. Their secu- 
rity was short-lived; for in July 1819, they were dismayed 
by the intelligence that their Prince had been attacked by 



26 ON EPIDEMIC CHOLERA. 

the disease in his palace, and his Prime Minister had died 
of it after a few hours' illness. 

"Pallida mors sequo pulsat pede pauperum tabernas 
Regumque turres." 

It soon spread among the inhabitants of the town, where 
it committed dreadful havoc. 

Before sketching its course through other parts of India, 
let us observe that after overrunning the district of country 
to the east of the hills as we have described, it halted for 
about eight or nine months, without the interposition of 
any cordon sanitaire — during all these nine months there 
was no impediment to the intercourse of the inhabitants. 
They went and came as heretofore, but the cholera remained. 
It did not cross with the stream of human activity, but bided 
its time. 

In March 1818, it first appeared in Allahabad, situated at 
the junction of the Ganges and the Jumna, and swept off 
about 10,000 of its inhabitants ; and a curious fact is, that 
the troops, though mixing freely with the townspeople, were 
not affected until the middle of the following July. Keep- 
ing close to the banks of the Ganges, it entered Cawnpore 
on the 8th of April. Passing over several intermediate towns, 
it attacked Shahanpoor in July, and destroyed 5000 of its 
inhabitants. 

It extended up the river Jumna in the same way, desolat- 
ing some places, while it spared others. It appeared in 
Matra as early as the beginning of June, while Agra, situ- 
ated lower down, was not attacked till July. Agra is a dry, 
airy town, and it suffered little ; Matra is filthy and crowded, 
and it suffered much. We may observe the principle of local 
election now coming into play. It committed great havoc 
at Delhi in July and August, and in Saharanpore in Septem- 



ITS MARCH. 27 

ber and October. Here it again encountered another edge 
of the basin, and could not be traced over the mountains. 

The Medical Board of Bengal, in a letter to that of Bom- 
bay, observes : — " The disease would sometimes take a com- 
plete circle round a village, and leaving it untouched, pass 
on, as if it were about wholly to depart from the district. 
Then after the lapse of some weeks or even months, it would 
suddenly return, and scarcely reappearing in the parts which 
had already undergone its ravages, would nearly depopulate 
the spot that had so lately congratulated itself upon its 
escape. Sometimes after running a long course on one side 
of the Ganges, it would, as if arrested by some unknown 
agent, at once stop ; and taking a rapid sweep across the 
river, lay all waste on the opposite bank. It rarely, how- 
ever, failed to return to the part which it had previously left. 
After leaving a district or town, it sometimes revisited it ; 
but in such cases, the second attacks were milder, and more 
readily subdued by medicine than those in the primary visi- 
tation/' The disease occurred in all seasons and weather, 
but changeable, damp weather seemed to favour it, and its 
progress was frequently arrested by a thunderstorm. Low, 
damp places were most liable to be attacked, and in such 
localities it has remained ever since its first appearance ; so 
that there are places such as Gooty, through which if 
troops be marched, they are almost certain to suffer from the 
disease. 

As our object is not to write a history of the diffusion of 
the cholera, but merely to narrate such facts as seem to us 
to cast a light upon the law of its progress over the world, 
we do not intend to follow its course farther in India, or to 
the East generally. Suffice it to say, that by January 1819, 
it had spread over the whole of the Indian peninsula ; and 
by 1820, it had added Siam and Malay to its dark do- 



28 ON EPIDEMIC CHOLERA. 

minions. It occupied those countries, as it were, by pre- 
scriptive right ; for in China, and over all India, it had long 
been at home as a sporadic disease. It was nothing new 
there, except in degree. Not so, however, as we trace its 
march to the West. Here it entered countries where it had 
never been seen before, and brought before the eyes of the 
inhabitants of Europe forms of death until then known only 
by tradition. 

We left the cholera in 1819 at the western borders of 
Hindostan ; it took two years to cross the intervening dis- 
trict between that and the other great eastern valley of 
the river Euphrates. In the summer of 1821, it raged with 
great violence on both sides of the Persian Gulf. At the 
town of Bussorah alone, it is said to have destroyed 14,000 
people in fifteen days — nearly 1000 a-day ! In September, 
it got as far as Shiraz, and committed great havoc ; 6000, 
out of a population of 40,000, having died of it. Bagdad was 
attacked about the same time. Again it went into winter 
quarters, to resume its campaign the following summer of 1822. 
At this time the Prince of Persia, Abbas Mirza, was carrying 
on war against the Turks, on the high table-land near the 
source of the Euphrates, when both armies were attacked by 
this invisible foe, which proved more deadly than their mutual 
liate. Mr. Baillie Fraser gives the following account : — " The 
Prince pursued his success as far as the pass of Deear, about 
three days' march from Topra Kullali, when the epidemic 
cholera, which had appeared in his camp even previous to the 
action, now broke out violently, and he thought fit to com- 
mence a retrograde movement to Khooe. From that moment, 
the Persian army also appears to have been virtually dissolv- 
ed. The men dropped off rapidly ; and whole troops deserted 
to return to their homes ; so that when he reached Khooe, he 
had scarcely any army to dismiss. The loss by disease was 



ITS MARCH. 29 

estimated at about one-tenth of the whole force ; although 
in some batallions 300 died out of 1000 men ; and the rear 
of their line of march was strewn with dead bodies, as if it 
had been all the way in action i" — almost the words used to 
describe the condition of the British army, under the Marquis 
of Hastings, in similar circumstances. The description of 
the disease at Tabreez, by the same writer, is interesting : — 
"It is difficult to say how or whence the epidemic cholera, 
that scourge of the East, reached Tabreez. It was supposed 
to have come from Bagdad, along the caravan road by 
Hamadan and Sennar ; but no accounts to be at all de- 
pended on could be obtained of its gradual progress. A 
whisper had gone forth that the disease had appeared in the 
town, as early as the 17th of July, but a week made it no 
longer doubtful ; and upon our return to Tabreez on the 
24th, after a short absence, we understood that from fifteen 
to twenty were daily dying of cholera. 

"During the next ten days, the state of the distemper 
varied greatly ; sometimes the fatal appearance diminished 
so much that it was doubted whether the alarm were not 
a false one. The sick were attacked with vertigo and sick- 
ness, which was attributed to the fearful effect of the sun's 
rays ; and though some died, yet some recovered without 
having evinced many of these more peculiar and alarming 
symptoms which generally mark the disease/' It is inter- 
esting to notice that, there as here, there was a premonitory 
morbid condition, indicating the approach of disease, and 
probably predisposing to it : but quite a different one. We 
direct attention to this now, as we shall have occasion to 
revert to the fact afterwards. To continue our description: 
— " By degrees, however, these symptoms disappeared ; vio- 
lent vomiting, accompanied with painful cramps, damp, 
clammy sweat, cold and bloodless extremities, burning heat 



30 ON EPIDEMIC CHOLERA. 

at stomach, a sudden death-like countenance, cessation of all 
the pulses : these, and other striking characteristics of this 
fearful disease, marked the fatal cases, and terminated in 
death. 

" Often when the disease was at its height, the first seizure, 
indicated by vertigo, proved fatal at once. Several instances 
came to our knowledge of persons thus attacked in the 
streets, who fell down senseless, and never recovered/'* 

About the same time that the cholera raged along the 
shores of the Persian Gulf, it appeared at Mecca, Medina, 
Damascus, and Aleppo, having spread over a great part of 
Arabia. Its rapid progress across the desert is of remark- 
able interest. It takes months or even years to get over a 
mountain range, traversed by thousands of people with all 
their merchandise, and it crosses the great Arabian desert, 
where a human being is seldom seen, and all is death and 
stillness, in a space of time unappreciable from its shortness. 

The eastern shores of the Mediterranean Sea, and the 
western shores of the Caspian, formed the extreme limits of 
its progress in 1823 ; and it then subsided entirely, and as it 
was hoped for ever. Nothing now was known of it for six 
years, so that it was not till 1829 that it suddenly broke out 
with its former violence in various parts of Persia. Again 
it subsided entirely during the winter months, but only to, 
revive with great malignancy in the spring of 1830. 

It broke out on the western shore of the Caspian Sea in 
June 1830, and committed great devastation in Georgia, 
confining itself chiefly to the towns situated along the valley 
of the river Kur, and extending by the beginning of August 
from Saliany, which is at the mouth of that river, to Tiflis, 
which is near the source. In this latter town, 238 persons 
died of it in six days, and the authorities gave the inhabit 
* Travels of Mr. Baillie Fraser, p. 316. 



ITS MARCH. 31 

tants permission to take refuge in the Caucasian mountains, 
at the base of which Tiflis stands. We do not hear of it 
ravaging the country between the Caucasus and the Volga. 
The chain of mountains seem to have been an effectual bar- 
rier to its progress as they have often proved to the advance 
of the Russians from another quarter. 

Instead of attempting to force the Caucasian passes, it- 
crept along the shores of the Caspian to Astrachan, at the 
mouth of the Volga, where it arrived on the 1st of August, 
and numbered nearly a hundred victims a-day. It also ex- 
tended along the rivers Terek and Kuma into the province 
of the Caucasians.* 

By the 21st of the same month, it had got as far as Sa- 
ratoff, still following the course of the river, and therefore 
advancing for a considerable distance in a north-easterly 
direction. Here it was very deadly, having within a month 
destroyed 2367 individuals. 

Matters now began to look serious in Russia. The enemy 
had got into the country, and seemed disposed to march up 
the valley of the Volga ; and if it did so, would soon arrive 
at the old capital of the Muscovite empire, Moscow, which 
was not prepared to re-enact the scene by which it had dis- 
lodged Napoleon. The Emperor of Russia seeing the alarm- 
ing prospect, adopted those stringent measures for defence 
which his absolute authority enabled him to put in execu- 
tion, in order to secure his great southern metropolis. Mos- 
cow, distant 1402 verstes from Astrachan, is situated on a 
table-land about 587 feet (French measure) above the level 
of the sea. On two sides of the town there run two rivers, 
which are connected by a canal, so as to form a triangular 

* See " A Treatise on the Epidemic Cholera, containing its history, symp- 
toms, autopsy, etiology, causes, and treatment," by Alexander Turnbull Chris- 
tie, M.D., London. 



32 ON EPIDEMIC CHOLERA. 

island ; this low-lying triangle embraces the larger part of 
the habitations of the poorer population, which consisted then 
of about 300,000 inhabitants. The city is surrounded by 
fortifications and barriers, so that access or exit is entirely 
under the control of the commandant, who has always a very 
large garrison to enforce his regulations. The first case oc- 
curred on the 14th of September, and the patient resided in 
the low triangle we have just mentioned. The man died on 
the 17th. On the same day, a soldier in the barracks, 
situated near this ground, took ill of symptoms resembling 
cholera ; and likewise a nun in a convent, situated at some 
height above this piece of ground, was seized with the dis- 
ease, and died on the 19th. Upon the 18th, a student at- 
tending the University was suddenly taken ill, and died in 
nine hours. 

On the 18th of September, a cordon sanitaire was formed 
all around Moscow, and the most stringent measures were 
adopted to prevent the ingress of any persons or articles of 
merchandise from an infected district, until they had been 
subjected to a quarantine of fourteen days and the necessary 
purification ; and as some cases had already occurred in the 
town itself, an order came out appointing a sanitary com- 
mission — dividing the town into districts, over each of which 
there was a " chef de quartier." Great powers were given 
to this commission, and a large sum of money was put at 
their disposal. They had orders to inspect, by means of 
proper officers, all the houses of the inhabitants, to establish 
hospitals wherever they thought fit, and generally to adopt 
such measures as were deemed advisable to arrest the pro- 
gress of the incipient plague. We have no doubt that they 
did their duty ; for a despotic power, such as Russia, enforces 
attention to its regulations in a very effective style. How- 
ever, notwithstanding all these precautions, within seventeen 



ITS MARCH. 33 

days the disease had developed itself in all the arrondis- 
semens; 459 had been seized, and 178 had died. Towards 
the end of September, the disease was at its height, and 
nothing but despair was depicted on every face. It was on 
the 29th of the month, that, with a devotion which we must 
all admire, at a time when it was universally believed that 
the disease was highly contagious, and when all intercourse 
between the infected parts of his empire was cut off, lest his 
subjects should perish, the Emperor Nicholas himself came to 
Moscow to calm the alarm and raise the spirits of its inha- 
bitants, and remained there till the 7th of October. This 
certainly is one of the most memorable royal journeys on 
record. 

In the month of October, there were 5532 cases, of which 
3107 were fatal ; and among these were many persons of the 
highest class. In November, it began to decline, and conti- 
nued to do so in December, when it seemed to pass into a 
kind of general influenza ; and rheumatic affections, which 
are common at that season, began to prevail. The cholera 
abated steadily till March 1831, when it ceased entirely for 
a time, to break out again in the following summer. 

On its first approach a manufacturer, who had fifty per- 
sons in his establishment, lost four by the disease ; he im- 
mediately removed the rest to a house in a higher situation, 
and from that time, there was no other case. 

The small town of Tcherkisowo, situated close to Moscow, 
and holding communication with it when the cholera was 
raging, was not attacked by it till the month of November. 
Thus it had lasted six weeks at Moscow, and committed 
dreadful havoc there before a single case occurred in this 
place, which lay at the very door.* 

* Rapport sur le Cholera Morbus de Moscou, par F. C. M. Markus, Secretaire 
du. Conseil temporaire de Medicine, &c. &c> Moscou, 1832. 

C 



84 ON EPIDEMIC CHOLERA. 

The total number of eases in Moscow was 6305, of which 
3533 were fatal. The daily seizures at one time were about 
fifty, and the deaths about half that number. About the 
same time that it had reached Moscow by one route, it 
reached Odessa by another ; but generally declined in the 
southern provinces of Russia, where it had shown itself dur- 
ing the winter of 1830. Having established itself on the 
borders of the Black Sea and Sea of Azof, it began to ascend 
the Danube in the winter of 1831, and appeared at Jassi on 
the 10th of May. By August it was in Vienna. While one 
division was thus penetrating into Europe by the south, 
another column, having set all the barricades of the Em- 
peror Nicholas at defiance, forcing its way in a westerly 
direction, spread towards St. Petersburg in the north, and 
over the Carpathian Mountains into Transylvania, and Hun- 
gary, and Poland towards the south. It attacked the towns 
of Brody and Cracow during that summer, and spread gene- 
rally over Galicia. In Hungary, it was computed that about 
19,000 persons fell sick, of whom 8266 died. We cannot 
trace its progress minutely from place to place throughout 
the extensive plains of Poland : it seems to have spread 
over them as the hordes of barbarians in a former age may 
have done, following no geographical lines, but occupying 
all the thickly peopled districts. 

Advancing to the north, it arrived at St. Petersburg on 
the 25th of June ; and here it changed its course, and went 
down the Gulf of Finland in a south-easterly direction. It 
entered Prussia by way of Castrin, Riga, Posen, and Stettin, 
knd occupied Berlin on the 31st of August 1831 ; and 
about the beginning of October, it made its appearance in 
Sunderland.* It made very little way in England during 

* Clanny on the Cholera of Sunderland. 



ITS MARCH. 35 

that year, and had entirely subsided by the 2d of January 
1832. 

Having traced the cholera thus far to its invasion of our 
own island, we shall not follow it any further in Britain, but 
return to the Continent of Europe. 

It broke out in Paris upon the 27th of March 1 831, and from 
that date to the beginning of August it had attacked 26,300 
persons. The total number of persons attacked in France, 
where it spread generally in 1833, destroying the fish and 
the fowls as well as the human race, was estimated at 
229,534 individuals, of whom 94,626 died. 

It did not reach Marseilles and Toulon till 1835.* 

"We have now with considerable minuteness traced the march 
of the cholera from the banks of the Granges to the shores of 
the North Sea ; and before offering any general reflections 
upon the facts we have brought together, we shall' advert to 
the course of the epidemic on its recent occurrence ; and we 
shall do this very shortly, for it would serve no purpose to 
go over exactly the same ground we have just quitted. In 
the words of a writer in the British and Foreign Medical 
Review for January 1849 : — 

" The disease always followed frequented routes and 
water-courses on which navigation was active, equally in 
1847 as in 1830. The governments which were most ex- 
empt in 1830-31 were this time also less severely attacked. 

" In the winter, the cholera lessened or disappeared ; it 
reappeared with the first warmth of spring. In all these 
particulars the cholera of 1847 has manifested a singular 
conformity w T ith the laws which seemed to govern it in 1830. 
In comparing the dates of attack in different governments, in 
the two epidemics, some very striking analogies are disco vered. 
The following table of the principal cities of the govern- 
* Ozanam, Op. Cit., p. 264. 



36 



ON EPIDEMIC CHOLERA. 



ments, and of the dates of attack in 1830 and 1847, is given 
by M. Laskgue : — 





WHEN 


ATTACKED. 




1830. 


1847. 


Tiflis 


July 1st 


May 5th. 


Kislar 


Middle of July 


End of May. 


Astrachan . 


July 31st 


June 21st. 


Zaritzyn 


August 13 th . 


Middle of August. 


Saratoff . . . . 


August 20th . 


August 25th. 


Zimbirsk . 


September 8th 


September 15th. 


Kazan 


October 4th 


September 17th. 


Georgiew . 


End of July 


End of June. 


Stawopol . 


September 6th 


July 16th. 


Novo-T scherhask 


September 10th 


July 13th. 


Taganrok 


October 8th 


August 15th. 


Kiew 


January 8th 


October 5th. 


Mohilew 


End of January 


October 18th. 


Karkhoff . 


September 23d 


August 23d. 


Woronesch 


End of September 


September 5th. 



" Too much stress must not be laid upon these coincidences, 
curious as some of them undoubtedly are. Moreover, we find 
important exceptions. Odessa and Orenburg, also, both 
suffered at periods differing from each other, in the two epi- 
demics. 

" In the further progress, there are also some singular 
coincidences. Thus cholera appeared at Moscow in the be- 
ginning of October 1830 ; at the end of September 1847. 
It appeared at St. Petersburg on the 25 th of June 1831 ; 
and in the beginning of June 1848. The first cases occurred 
in Berlin on the 31 st of August 1831 ; about the 12th of 
August 1848. In our own country the coincidence has 
failed, for cases of cholera have already occurred in places 
situated in all parts of the kingdom, from Edinburgh to 
Plymouth, within a short space of time/' 

Having tracked this deadly visitant round half the globe, 
we naturally come to inquire by what force it has been im- 
pelled, and by what conditions it has been limited or directed. 



ITS MARCH. 37 

We may be able to arrive only at negative conclusions on 
this subject, but that is always nearer the truth than posi- 
tive error. 

Did it advance from India hither by contagion ? Let us 
first look narrowly at the meaning of the affirmative answer 
to this. Supposing one person has a disease, and another 
person, previously well, touches him, and takes the same dis- 
ease, and in his turn, comes in contact with another, and 
another, and another, and they all take it, and in their turn 
give it to all they meet — then that disease is spreading by 
contagion. In doing so, it will tend to spread in circles, 
like ripples from a stone thrown into the water, augmenting 
as they retire from the original centre of disturbing force. 
The circular form will be retained as long as there is surface 
enough of water to afford room for a complete circle, and 
when it comes in contact with a bank, then the waves will be 
in segments of circles. They never can lose altogether their 
tendency to a circular character. The same is the case with 
a disease which advances by contagion alone. It should 
spread in ripples among the population where it first ap- 
peared, and gradually enlarge the circumference of its 
sphere until it had embraced all who were susceptible of its 
influence. The only determining condition would be the 
density of the population ; it should spread more rapidly in 
a dense than a sparse community. It never could spread at 
all where there were no people, any more than a fire could 
spread without fuel. It would always be found along the 
line of human intercourse, and nowhere else. It would go 
from place to place with men — whether they went by ships, 
by canals, by railway, or go how they would, if it spread by 
human contact, they could no more get rid of it than can a 
villain get rid of his guilty conscience by change of place. 
It would attend man like his shadow. Such are the obvious 



38 ON EPIDEMIC CHOLERA. 

conditions of a disease which owes its power of advancing 
to contagion. Let us try whether they suit the cholera. 

The overland mail from India takes about six weeks to 
reach this country. The cholera took thirteen years. It 
would hardly have suited Sir Charles Napier to have been so 
long on the road. 

When it first broke out in Hindostan, it spread like fire 
over a dry prairie, but did not cross the Ganges. We have 
no means of knowing how many thousands crossed that river 
and travelled east during the time the plague was ravaging 
the plains of the west. The numbers must have been im- 
mense ; they went from the cholera — they did not take it 
with them. It ran up the Ganges and up the Jumna ; it 
missed some towns and assailed others ; there was no bar- 
rier to the intercourse between the places where it raged 
and those which were exempt, and yet it did not spread 
laterally — it kept in a given direction. It attacked the Bri- 
tish army, and thousands died. The army decamped with the 
disease in its bosom, and when it had removed to a little dis- 
tance from its former location, the disease subsided. When it 
got to the hills west of the basin of the Ganges, it stopped for 
the winter ; during all that time, men, women, and children 
were pursuing their pilgrimage to the west, and yet it went 
not. When it had stopped the operations of the Persian 
army at the sources of the Euphrates, the disbanded army, 
many of whom were sick of it, did not diffuse it in the 
country they occupied. It crossed the Desert, where the 
Israelites wandered for forty years, like a flash of lightning 
— appearing simultaneously on its east and west border. It 
continued, notwithstanding the Emperor's stringent measures, 
as regardless of them as was the sea of the satyrical inter- 
dict of Canute, to advance step by step over his broad domi- 
nions, sometimes creeping slowly up a river, and sometimes 



ITS MARCH. 39 

traversing the wide plains swifter than the fleet Cossacks, who 
are their only inhabitants. It convinced those who had most 
to do with it, that it was altogether in vain to attempt to arrest 
its progress by quarantine measures.* Seven hundred and 
sixty vessels arrived from places where cholera was raging, 
at different ports of Britain, and not a case occurred on board 
the vessels, or at the quarantine stations outside the Cate- 
gat Sea.-f* It did not go where men were thickest ; it went 
fastest where there were no men. It therefore did not ad- 
vance by contagion. We do not say that it is not conta- 
gious ; on the contrary, we intend to reserve the discussion 
of that for the next Chapter ; but we say that the hypothesis 
of its contagiousness never could be made to account for its 
course from India to this country. 

The few conditions of its progress that we have become 
acquainted with are the following : — It has a decided affinity 
for water. By casting a glance at the map which accom- 
panies this volume, this will be recognised at once. It has 
a strong tendency to run up rivers, even to their very source. 
It frequently declines in winter, to revive with the approach 
of summer. It is most fatal in large, low-lying towns. It 
passes rapidly over plains ; it finds difficulty in getting over 
hills. It has hitherto confined itself to certain parallels of 
latitude. Its progress is generally most rapid in autumn, 
and its course is in a westerly direction. 

These are nearly all the unquestionable facts taught us 
by its two successive invasions of Europe. 

The next question we come to discuss is a most obscure 
one. It is this. Since contagion fails to account for the 
progress of cholera all round the world, by what force is it 

* See the Report of the Moscow Board of Health. 

f Documents transmitted by the Central Board of Health to the Privy 
Council, 1832. 



40 ON EPIDEMIC CHOLERA. 

impelled ? To this we shall not venture any answer, but 
throw out the few suggestions which have occurred to us in 
the course of our reading and meditation upon the subject. 

There is something very dreadful in the idea of an infected 
atmosphere. Against poison in other forms we can guard. 
We can analyze our food, and even for a time abstain from 
eating. But we must breathe or die ; and it is a frightful 
alternative to know that if we do breathe, we must also die. 
Yet so it is. The viewless, scentless, impalpable air, the 
breath of life, is sometimes charged with a poison so power- 
ful that no organism can withstand its baneful influence, and 
yet so subtle that no chemistry can detect its presence. No 
wonder that when this is known to be the case, a most 
anxious investigation of all atmospheric phenomena should 
be made, and everything which was supposed to be unusual 
about these, should be associated with the taint which af- 
fected the air. As yet we might report upon this depart- 
ment of the subject in the words of Lord Bacon : — " Spe 
fallente, progressu haud prospero, fructu parco et exiguo, 
cum contemnendo aut plane nullo successu." 

This much is certain, that there must be " something in 
the air" when the cholera rages. It is in the air, for it affects 
the aerial inhabitants. When the cholera came to Peters- 
burg, the crows forsook their old roosting-places, and the 
swallows their nests, and disappeared altogether during the 
time it was there.* Yet it was not of the air, for it has 
been observed not to be affected by wind ; and indeed in 

* Einige Bemerkungen iiber die Asiatische Cholera, fur ^Erzte, nach eigener 
Erfahrung gesammelt auf einer zur Beobachtung des libels unternommenen 
Reise, vonC. Muller, Dr. Med. Hannover, September 1848. Also, Observations 
on the Asiatic Cholera, by Adair Crawford, Esq., M.D., Metropolitan Sanitary 
Commission. As we shall have occasion to refer to these pamphlets again, we 
may here observe, that Dr. Muller was sent by the Hanoverian, and Dr. Craw- 
ford by our own Government, to investigate the cholera in Petersburg, and 
these are their "Keports." 



ITS MARCH. 41 

gome places, as Russia, it seemed to prefer moving always 
against the wind. 

Although in the present state of meteorology, when we 
cannot even predict whether the morrow will be wet or dry, 
hot or cold, it would be absurd to expect anything approach- 
ing to a scientific reply to the question which every one puts, 
— What is it in the air which causes this or any other fatal 
epidemic? yet a few positive observations have been made 
which seem to establish as a fact, that during the prevalence 
of cholera, there often is a disturbance of the ordinary at- 
mospheric phenomena. We shall select a few examples of such 
observations ; and as the reports about weather are generally 
framed in a very loose style, lest we should make bad worse 
by giving an incorrect account of these reports, we shall em- 
ploy the words of the observers themselves. Our first autho- 
rity is Dr. Prout : — 

" The matters occasionally diffused through the atmos- 
phere, which appear to be in a state of solution, are not often 
perceptible by our senses, unless in some cases, perhaps, by 
the sense of smell. 

" As an instance of the presence of such bodies in the 
atmosphere, we may mention a very remarkable observation 
which occurred to the writer of this treatise during the late 
prevalence of epidemic cholera. He had for some years 
been occupied in investigations regarding the atmosphere ; 
and for more than six weeks previously to the appearance 
of cholera in London, had almost every day been engaged 
in endeavouring to determine, with the utmost possible ac- 
curacy, the weight of a given quantity of air, under precise- 
ly the same circumstances of temperature and of pressure. 
On a particular day, the 9th of February 1832, the weight 
of the air suddenly appeared to rise above the usual stan- 
dard. As the rise was at the time supposed to be the result 



42 ON EPIDEMIC CHOLERA. 

of some accidental error, or of some derangement in the ap- 
paratus employed, in order to discover its cause, the suc- 
ceeding observations were made with the most rigid scrutiny ; 
but no error or derangement whatever could be detected. On 
the days immediately following, the weight of the air still 
continued above the standard, though not quite so high as 
on the 9th of February, when the change was first noticed. 
The air retained its augmented weight during the whole 
time these experiments were carried on, namely, about six 
weeks longer. The increase of the weight of the air ob- 
served in these experiments was small ; but still decided 
and real. The method of conducting the experiments was 
such as not to allow of an error, at least to an amount so 
great as the additional weight, without the cause of that 
error, having become apparent. There seems, therefore, to 
be only one mode of rationally explaining this increased 
weight of the air at London in February 1832, which is, 
by admitting the diffusion of some gaseous body through 
the air of this city, considerably heavier than the air it 
displaced. About the 9 th of February, the wind in London, 
which had previously been west, veered round to the east, 
and remained pretty steadily in that quarter till the end of 
the month. Now, precisely on the change of the wind, the 
first cases of epidemic cholera were reported in London ; and 
from that time the disease continued to spread. That the 
epidemic cholera was the effect of the peculiar condition of 
the atmosphere, is more perhaps than can be safely main- 
tained ; but reasons which have been advanced elsewhere, 
lead the writer of this treatise to believe that the virulent 
disease, termed Cholera, was owing to the same matter that 
produced the additional weight of the air." 

Dr. Clanny, " Medical Member of the Board of Health" at 
London, writes in 1831 : — " We had several severe thunder- 



ITS MARCH. 43 

storms, and consequently sudden changes of the weather, 
in the months of September, October, and November. The 
commencement of the epidemic cholera was, according to 
my personal observation, about the beginning of the month 
of October ; and I find in my memoranda of cases, that 
on the night between the 2d and 3d of November, much 
lightning occurred ; and it is worthy of remark, that exactly- 
at this time, our first five fatal cases were drawn up and re- 
ported to the Board of Health at London. Upon the 2d of 
November, we had no new cases ; nor upon the 3d, 4th, and 
5th ; but upon the 6th, we reported six new cases, and two 
deaths ; and upon the night between the 6th and the 7th, we 
had continued flashes of lightning during the whole night 
— an unusual phenomenon at this season of the year/'* 

" Unnatural times do breed unnatural troubles." 

Dr. Miiller, speaking of St. Petersburg during the pre- 
sent epidemic, observes :-f- — " The air, during the whole time 
of the presence of the cholera here, was oppressive, heavy, 
and very changeful in its degrees of temperature. There 
were frequent thunderstorms, but they had no influence in 
making people ill or restoring them to health. [A bold asser- 
tion !] Rain fell almost daily. The sky was gloomy — very 
misty in the evening ; the sun seldom broke through. The 
depressing influence, (die muthlose Stimmung,) the peculiar 
constitution of the atmosphere acted, more or less, upon every 
one ; almost without exception, all experienced a certain 

* Hyperanthraxis, or the Cholera of Sunderland, by W. Reid Clanny, M.D., 
F.R.S.E., M.R.S.A., Physician to H. R. H. the Duke of Sussex, &c. &c. We give 
some of his titles to show that he is a man of learning and standing ; for at 
first sight it seems odd to invent a special Greek name for the " Cholera of 
Sunderland." It would be a curious Babel-language, if every town where the 
cholera appeared returned a Greek member of the medical parlcment (to adopt 
the old spelling). 

f Op. Cit., p. 5. 



44 ON EPIDEMIC CHOLERA. 

feeling of discomfort, weariness, pressure at the pit of the 
stomach, and tearing pains on the lower limbs." Our last 
quotation shall be from Dr. Crawford's Report, p. 5 : — 

" STATE OF THE WEATHER IN RUSSIA IN 1848. 

" The last winter in Russia was dry, moderately cold, and 
the fall of snow much less than is usual. The spring set in 
very early, the Neva being clear of ice, and the navigation 
open nearly a month sooner than is generally the case. The 
weather was fine and dry, and the temperature mild, in 
March, April, and the beginning of May. There was a great 
prevalence of severe influenza, complicated with sore throat, 
in February and March ; and in April and May, the number 
of cases of intermittent fever, and also of diarrhoea and dy- 
sentery (complaints generally prevalent at that season), was 
greater in the hospitals than in ordinary times. During the 
latter end of May and the whole of June, a remarkable change 
took place in the weather. There were almost constant high 
winds, shifting frequently and suddenly round to every point 
of the compass, and often accompanied with torrents of rain, 
and sometimes thunder. This disturbed state of the atmos- 
phere was indicated by sudden fallings and risings of the 
barometer, sometimes to the extent of between one and two 
inches. The changes of temperature were equally frequent 
and rapid ; the heat being, for several days together, very 
great, as high as from 84° to 90° of Fahrenheit, and the air 
extremely sultry and oppressive, with a damp relaxing south 
wind ; and then suddenly, on a change of wind, and some- 
times on the occurrence of a thunderstorm, this oppressive 
heat would be succeeded by great cold, the thermometer fall- 
ing as much as 50° in a few hours, so that it was several 
times in June nearly as low as the freezing point. 

" Another peculiarity in the condition of the air was the 



ITS MARCH. 45 

disturbed state of its electricity. This was clearly demon- 
strated by the fact, that the electric machines could not be 
charged, and to a great extent lost their power, as generally 
happens whenever the atmosphere is damp and unsettled. 
The same remark was made respecting the strength of several 
large magnets ; and it has been reported since I left St. 
Petersburg, that the weather having become more settled, 
the electric machines and magnets have recovered their 
power. This disturbed condition of the electricity of the air 
was also indicated by the peculiarly depressed and uneasy 
state of feeling which almost everybody complained of more 
or less ; some entirely losing their sleep, whilst others slept 
more heavily than usual. Few persons, in fact, during that 
period, escaped suffering from some degree of derangement 
in their health/' 

Dr. Crawford's last observation in regard to the electric 
phenomena is very interesting, for to this point we natu- 
rally turn for some light upon the mysterious influences 
which pervade the atmosphere during the prevalence of any 
deadly distemper. We find that thunderstorms have fre- 
quently been observed to attend epidemics ; we know that 
our frames are powerfully affected by the electric condition 
of the air ; and further, while the positive electricity de- 
creases from sunset, and reaches its lowest point between 
sunset and sunrise, it has been observed that persons are 
generally seized with cholera in the night-time.* 

The intimate relation of electricity to magnetism in all its 
branches, naturally leads us to the researches of Reichen- 
bach ; and certainly it is a very curious fact, that sensitive 
persons, and they alone, should be affected by the current 
which is always in the line of the magnetic meridian. We 

* Markus, op. cit., p. 104, who quotes Delanay's Memoirs in corroboration of 
this remark. Also Orton, and Scot, and many other observers. 



46 ON EPIDEMIC CHOLERA. 

shall quote at some length the observations of Reichenbach 
upon this subject : — 

" 59. Having detected in crystals a force, which, although 
quite different from magnetism, yet exhibited a very marked 
analogy with it ; and considering, on the other hand, that 
animal magnetism, although likewise different from ordi- 
nary magnetism, yet showed a similar analogy to it, he was 
led to inquire, whether he could discover any common pro- 
perties in the phenomena of these two forces, and to what 
extent ? And also, w r hether animal magnetism, like the 
crystalline force, might not be subject to physical laws ? As 
crystallization seems to mark the transition from organic to 
inorganic nature, he ventured to hope, that by experiment 
he might discover a point of connection between animal 
magnetism and physics, or perhaps even obtain, for animal 
magnetism, that firm foundation in physics which had so 
long been sought for in vain. 

" 60. But to prepare the way, it appeared, above all things, 
necessary to ascertain the part which in all these pheno- 
mena is played by terrestrial magnetism. If a magnet or a 
crystal produces so decided an effect on sensitive persons, it 
is certain that the magnetism of the earth, which gives the 
needle its direction, cannot be without influence on the 
animal nerve. And thus it was obvious, that it would be 
impossible to obtain any pure result from any experiment as 
long as this powerful agent, which must act in some way, 
was not subject to measurement and calculation, with a view 
to its elimination. With this idea, trials were made with 
both healthy and diseased individuals, as M. Schuh, M. 
Schmidt, surgeons; Mdlles. Nowotny, Sturmann, Maix, 
Reichel, Atzmannsdorfer, and others, in different circum- 
stances and at different times. 

" 61. M. Schuh had, in the house then inhabited by him, 



ITS MARCH. 47 

the singular custom, when lie awoke early in the morning, 
of regularly turning himself in bed, so as to place his head 
where his feet had been ; on doing this, he invariably fell 
asleep again, and this second sleep, contrary to the usual 
opinion, was to him far more refreshing than the whole sleep 
preceding it. If he omitted this, or lost his second sleep, he 
felt weary all day, and thus this strange custom had become 
a necessity for him. The author inquired, and found that 
the position of the bed was such, that the head of the sleeper, 
in his ordinary position, that is, the head of the bed, was 
directed to the south, the feet to the north. He advised the 
turning of the bed into exactly the opposite position, with 
the head toward the north ; and from that time, the neces- 
sity for the second sleep never returned, the ordinary sleep 
was refreshing and sound, and the custom above mentioned 
at once given up. 

" 62. M. Schmidt had experienced, in travelling, a chill in 
the right arm, and had suffered for some time from violent 
rheumatism, with most painful cramps, from the shoulder to 
the fingers. He was treated by his physician with a mag- 
net, which relieved the cramps, although they always re- 
turned. He lay then with his head to the south ; on the posi- 
tion being reversed, so that he lay in the magnetic meridian 
with his head to the north, he immediately felt comfort and 
relief. Instead of shiverings, he now felt an agreeable uni- 
form warmth, the passes with the magnet were now much 
more cooling and beneficial than before ; and before the 
author left him, the stiffened arm and fingers were quite 
moveable, and the pain had disappeared. 

" 63. On examining the position of Mdlle. Nowotny, she 
was found lying almost exactly on the magnetic meridian, her 
head towards the north. She had instinctively chosen this 
direction, and it had been necessary to take down a stove to 



48 ON EPIDEMIC CHOLERA. 

allow her bed to be placed as she desired it to be. She was 
requested, as an experiment, to lie down with her head to 
the south. It took several days to persuade her to do so, 
and she only consented in consideration of the weight which 
the author attached to the experiment. At last, one morn- 
ing he found her in the desired position, which she had as- 
sumed very shortly before. She very soon began to com- 
plain of discomfort, she became restless, flushed, her pulse 
became more frequent and fuller, a rush of blood to the head 
increased the headach, and the sensation of nausea soon 
attacked the stomach. The bed with the patient was now 
turned, but was stopped half-way, when she lay in a mag- 
netic parallel, with the head to the west. This position was 
far more disagreeable than the former ; indeed, absolutely 
intolerable. This was at half-past eleven, a.m. She felt as 
if she would soon faint, and begged to be removed out of 
this position. This was done, and as soon as she was re- 
stored to the original position, with the head to the north, 
all disagreeable sensations diminished, and in a few minutes 
were so completely gone, that she was again cheerful. But 
besides these very disagreeable feelings which acted pro- 
foundly on her, in the altered position, all her sensations, in 
regard to external matters, were altered. For example, the 
streaking with a magnet, usually so agreeable, was now dis- 
agreeable ; and if strong, intolerable ; and, in short,, all her 
relations to different substances took a new and very differ- 
ent form. 

" All these experiments were at different times repeated, 
and with exactly the same results. She could hardly endure 
the position from west to east, or that from east to west, more 
than a minute, without feeling all the symptoms above de- 
scribed, with a tendency to syncope, and recovered instantly 
when the position was changed to that of north to south. 



ITS MARCH. 49 

" As she had long been affected with a gradually increasing 
illness, the author inquired if at any former period this sen- 
sibility to position had occurred ; and it appeared that she 
had lived in different houses, and had suffered uneasiness in 
some, while in others she had felt comfortable, without the 
cause being known. Her brother was now told to take a 
compass and ascertain the position of her beds in the differ- 
ent houses, as well as of her couches and work-chairs. It 
was found that in one house her bed and couch had acci- 
dentally been almost exactly in the magnetic meridian, and 
that she had lain with her head towards north, not towards 
south. In another house she had lain in a line north-east 
and south-west. In fact, she had been comfortable in the 
former, while in the latter she had always suffered and 
struggled with illness. Even now, without knowing why, 
she could not bear to sit across her bed or sofa, neither 
could she lie on the sofa, but could only bear to lie in bed. 
In the first case her position was from west to east, in the 
second east to west, in the third south to north ; only in 
the last could she obtain the indispensable position from 
north to south. 

" Of all positions, the worst by far was that from west to 
east, that is, the head to the west. 

" 64. Mdlle. Sturmann, in consequence of violent dancing, 
3 years before, was attacked by her illness. She now suf- 
fered from tubercles in the lungs, and was subject to cata- 
leptic attacks. The author found her lying in the position 
from west to east. In this position, the great magnet 
(carrying eighty lb.) placed above her head or under her feet, 
had hardly any effect. She was then placed in the position 
from north to south. The change was instantaneous. The 
patient at once expressed a feeling of comfort, the previously 
existing restlessness ceased ; a painful sensation of heat in 
the eyes, which had constantly annoyed her, disappeared, 

D 



50 ON EPIDEMIC CHOLERA. 

and in its stead she felt an agreeable coolness ; a universal 
relief obviously spread over her whole being. Then followed 
a night of singularly sound sleep, such as for a long time she 
had not had. Another time the position from south to 
north was tried, with an equally rapid change for the worse : 
general restlessness, flushing, oppression of the head, and 
burning sensation in the eyes, at once returned ; and all 
were, so to speak, as easily put an end to as soon as the 
patient again occupied the position from north to south. 
While she was in this, the normal position, the author again 
tried the magnet. But what a change ! At the distance of 
four paces from the head, he removed the armature of the 
magnet. The patient did not speak, and was found insen- 
sible and affected with tonic spasms. After her recovery, he 
again, at seven paces from her feet, removed the armature, 
and she had hardly spoken a word when she became speech- 
less, and fell again into the same state. A third time he 
went, in the line of the magnetic meridian, as far as the 
ward permitted, upwards of thirty feet from her feet. When 
the armature was removed, she did not instantly feel any- 
thing, but after about a minute she ceased speaking at once, 
in the middle of a word which was actually on her tongue. 
She was suddenly seized, and was found lying in convulsions, 
with clenched hands, her eyes open and turned upwards ; so 
unconscious that he could lay his finger on the cornea with- 
out her moving the eyelids. What a difference of effect ! 
The same magnet which had been placed above her head 
and under her feet without any marked action, while she lay 
in the line of a magnetic parallel, now when she lay in the 
meridian, struck her down senseless at the distance of thirty 
feet. 

" 65, Mdlle. Maix, who was neither cataleptic nor somnam- 
bulist, gave similar results ; she could only endure the posi- 
tion from north to south, and that from west to east was of 



ITS MARCH. 51 

all the most intolerable. In her case, the experiment was 
tried in the afternoon, while with Mdlle. Nowotny, it was in 
the forenoon. 

" 66. Mdlle. Reichel also perceived a very marked differ- 
ence : and as the author found her bed in the position from 
south to north, he recommended a change to that from north 
to south. From this change she derived much benefit, her 
rest being much improved. 

" 67. Mdlle. Atzmansdorfer, on two occasions, one in the 
morning, the other in the evening, could only bear the posi- 
tion from north to south, and found that from west to east 
the most disagreeable. 

" 68. All these patients now recollected bow painful and 
disagreeable it had always been for them to remain in church, 
although they could never tell why. But as all Catholic 
churches are built from east to west, those in front of the 
altar are necessarily in the position from west to east, which 
to all sensitive persons is the most intolerable. In fact, 
these patients, in that position, had often fainted and been 
carried out of church. At a later period, Mdlle. Nowotny 
could hardly ever bear to walk in the garden or on the street 
from west to east, if it lasted for some time. 

" 69. Thus, eight different cases of sensitive individuals 
agreed in this, that every other position, except that from 
north to south, is highly disagreeable, but that from west to 
east almost intolerable, at least in our hemisphere. Pro- 
bably in the southern hemisphere it is otherwise. The cause 
of these phenomena can obviously be found only in that great 
magnet which is formed by the earth with its atmosphere, 
that is, terrestrial magnetism. Like any other magnet, the 
earth interferes, and we thus arrive at the following law : — 
The terrestrial magnetism exerts on certain persons, both 
healthy and otherwise, who are sensitive, a peculiar influence, 
powerful enough to disturb their rest, and in the case of dis- 



52 ON EPIDEMIC CHOLERA. 

eased persons disturbing the circulation, the nervous func- 
tions, and the equilibrium of the mental powers/'* 

Let it not be supposed that we wish to identify the mor- 
bific force which produces cholera with electricity or magnet- 
ism in any of its forms. Our only design is to direct at- 
tention to the remarkable fact that there is constantly in 
the atmosphere a subtle force moving in a given direction, 
which has the power of affecting with severe illness persons 
peculiarly susceptible to its influence, and that thus it offers 
a closer analogy than any other constant natural force with 
the peculiar morbific influence we are now considering. 

Before leaving this' part of the subject altogether, we are 
tempted to add one observation. It has been remarked by 
various writers that the electric force in all its various modi- 
fications is the great antagonist to the force of attraction. 
The one is, to borrow a phrase from political life, the con- 
servative and the other the radical power. Attraction holds 
things together, binds the planets to their suns ; the electric 
force gives life and activity to the materials of which all 
matter consists. Neither vital nor chemical action can go 
on without it. The course of the earth, in obedience to the 
general law of gravitation, is from west to east, the course of 
epidemics is from east to west. 

Again, we disclaim any intention of building a hypothesis, 
but we throw out these random hints in the hope of stimu- 
lating the curiosity of observers, and inducing them to direct 
their investigations in the direction where we have most hopes 
of discovering the laws by which the mother earth, with its 
mantle of air, " its glorious canopy of light and blue/' is so 
intimately united with all that dwell upon its surface. 

* Abstract of "Researches on Magnetism and on Certain Allied Subjects," 
including a Supposed New Imponderable. By Baron von Reichenbach. Trans- 
lated by William Gregory, M.D., Professor of Chemistry in the University of 
Edinburgh. 



CHAPTER II. 



IS IT CONTAGIOUS ? 



We have done with the march of cholera from India to 
Britain, and we now come to speak, hot of its progress, but 
of its diffusion. This is not only a different question but 
one which requires an opposite method of investigation. 
As an illustration, let us suppose that we wished to explain 
such a phenomenon as this. A wind is observed to blow al- 
ways in a given direction from south-east to north-west, and 
this wind is of a peculiar quality, and as it proceeds on its 
course, it spreads to a certain extent through the surround- 
ing atmosphere. In seeking to determine the force and 
direction of this moving column of air, we must take the 
measurement of the earth as the basis of our calculation, and 
we may arrive at the conclusion that the phenomenon is 
caused by the difference in the velocity of the atmosphere 
at the poles and at the equator ; but this does not bring 
us a step nearer the explanation of its diffusion. To as- 
certain this we must make a series of experiments, as well 
as observations, and by doing so in the laboratory we 
may arrive at the knowledge of the law that gases tend to 
intermingle with one another in the inverse ratio of their 
density. The knowledge of this latter law would not at all 
assist us in explaining the trade-winds, any more than 
would the trade-winds explain the diffusion of gases. So 



54 ON EPIDEMIC CHOLERA. 

it is with the question now opening to us. In tracing the 
march of cholera, we sought as high a point of view as pos- 
sible, that we might survey an immense extent of the earth's 
surface, and estimate aright the strides of the destroying 
angel. This was absolutely necessary, when many degrees 
of longitude intervened sometimes between his footsteps. 
It was like following the course of some mighty conqueror 
with a telescope from a point far above the earth. To 
determine the important question of the contagiousness of 
cholera, we must track it from house to house, from room to 
room, from bed to bed. We must prepare ourselves for in- 
vestigating the most minute particulars, like a police-officer. 
The one would be the task of a Fouche, the other that of a 
Humboldt. 

We want to make out whether the cholera is contagious 
or not. Let us first distinctly understand what we mean 
by contagious. Suppose a person has got small-pox, and 
six other persons attend him, and two of the six on going 
home fall ill of small-pox, and six persons attend each 
of them in their separate abodes, and again two of each of 
the six take the disease likewise, and so on until it is a 
notorious fact among the community that a person who has 
been in attendance upon another having small-pox, is more 
liable to be attacked by the disease than his neighbours, 
who do not come in contact with persons so affected ; then 
we say that small-pox is contagious. 

The simple common-sense view of the matter is, that 
communication with the sick gives a liability to the parti- 
cular disease they suffer from. Nobody says that contact 
with the sick is the only way of getting the disease, other- 
wise how did the disease first begin ? There must have been a 
first case of every disease ; and unless we suppose that Adam 
on his expulsion from Eden was immediately smitten with 



IS IT CONTAGIOUS ? 55 

all infectious diseases — which is hardly compatible with his 
maintaining himself and Eve by his exertions, and founding 
a family which has lasted for six thousand years — some one 
of the human race must have become spontaneously ill of 
a disease which afterwards he gave to his neighbours. 

Here, then, is the first stumblingblock — a disease may 
be contagious, and yet arise without contagion. There is 
little doubt that typhus fever is contagious, and as little that 
it attacks persons in certain localities who have not been 
exposed to contagion. 

The next ambiguity we encounter is, that contagion is 
almost never universal. If it were so our race would have 
been extinct long ago. Only certain persons are liable even 
to the most contagious diseases. There are many examples 
of heroic exposure to " the plague/' both by physicians and 
priests, many of whom escaped the disease ; so that we can 
hardly conceive a more senseless proceeding than experi- 
menting on oneself with a disease reputedly infectious ; as 
for example, wearing the clothes of persons who had died of 
cholera, or sleeping in the bed of a cholera patient, and then 
if no bad consequences followed, holding that up as a proof 
that the disease is not contagious. It only proves that the 
very foolish individual happened not to be liable to its in- 
fluence. 

We start then with these preliminary assertions, that dis- 
eases of the most certainly contagious character occur with- 
out contagion, and that all persons are not liable to any, even 
the most virulent contagion. 

Before investigating the facts which bear upon the con- 
tagion of cholera, we propose giving a summary of those 
which bear upon the contagion of plagues, that we may 
have a sort of model before our eyes ; and for this purpose 
we sh^ll take as an example the plague at Marseilles, in the 



56 ON EPIDEMIC CHOLERA. 

year 1720, as affording useful instruction in all the points 
we hold it of importance to bear in mind. Our chief autho- 
rity is Russell's History of the Plague, and when no other 
work is referred to, this clear and able narrative is the 
source of our information. 

According to Dr. Russell, (the author of the History of 
Aleppo,) the plague raged with unusual violence in Syria in 
the year 1819 ; and, as is usual in such circumstances, great 
numbers had fled to the coast, and the sea-port of Sidon was 
almost certain to have many of the infected among its visi- 
tors. It actually broke out there in the beginning of February 
1720. A few days before its outbreak, upon the 31st of 
January, a ship, laden with the usual spoils of the East, left 
the harbour, having a clean bill of health, and destined for 
Marseilles. Having sustained some damage from storms, she 
put into Tripoli, where she was repaired, and took in some 
Turks and merchandise. Soon after she left Tripoli, one of 
these passengers fell ill, and died. Two of the sailors pre- 
pared to throw the corpse overboard, but desisted at the 
desire of the captain, and left the ceremony to be performed 
by some Mohammedan passengers. They had touched the 
body, however. Within a few days both the sailors were 
taken ill, and died. The ship touched at Cyprus, and landed 
her remaining passengers, glad to escape, no doubt. Soon 
after leaving Cyprus, another sailor and the surgeon died 
very suddenly. Before reaching Leghorn, three more sailors 
were taken ill, where they were landed, and soon afterwards 
died. We have thus seven deaths among the crew of a 
trading vessel in the course of a few weeks ; that vessel 
being come from a port where the plague was known to rage 
a few days after the ship had quitted it. There cannot be 
a doubt as to the dreadful character of this vessel's freight 
now. Notwithstanding her clean bill of health, the plague 



IS IT CONTAGIOUS ? 57 

was on board ; and Captain Chataud, who commanded her, 
kept himself aloof from the rest of the crew, and had all the 
bedding of those who died destroyed. He, at least, was of 
opinion that this fatal disease was contagious. 

While this ship was making its voyage down the Medi- 
terranean, the town of Marseilles was in its usual state of 
health, and little aware of the dangerous cargo to which it 
was opening its ports. — " Two days after the arrival of this 
ship, one of the sailors died ; on the 1 2th of June, an officer 
of quarantine, who had been put on board, died also ; and 
tins was followed by the death of a cabin boy on the 23d. 
About the same time, some porters employed in opening the 
merchandise, in the Lazaretto, were taken ill, and died ; in 
the first week of July, three others fell sick in like manner ; 
but in these, buboes were discovered in the axilla and groins. 
The surgeon of the Lazaretto, who had hitherto ascribed the 
alarming mortality to ordinary fevers, now, for the first time, 
expressed his suspicion, and a consultation being held with 
two other surgeons, they, after visiting the sick, gave their 
opinion in the most express terms to the Council of Health, 
that the three patients had the plague. This was on the 
8th, and all three died next day. The priest who had ad- 
ministered to the sick, and the surgeon of the Lazaretto, 
with part of his family, were infected also, and died. 

" According to the historical account, the distemper dis- 
covered itself in the city about the 20th of June ; but in- 
stances were rare before the first of July, when several acci- 
dents happened in the Rue de l'Escale. On the 9th, Messrs. 
Pissonel, physicians, gave information of a young man taken 
ill in another quarter of the city ; the sister was taken ill 
the next day, and the brother died. She, with the rest of 
the family, were transported to the Lazaretto, where they 
all perished. It should be remarked, that the passengers in 



58 ON EPIDEMIC CHOLERA. 

the ships which arrived afterwards from the Levant, the 
end of May and in June, notwithstanding they brought foul 
patents, having performed only the usual quarantine of six- 
teen or nineteen days, were admitted into the city soon after 
the middle of June. Of these, one named Boyal, died with 
a bubo in the arm -pit. From the 12 th of July to the 23d, 
there was a deceitful pause, during which the popular appre- 
hensions began to subside. The physicians were reproached 
with ignorance in having mistaken ordinary fevers for the 
plague ; and the precautions taken by the sheriffs were con- 
demned as unnecessary. The disease however, in this inter- 
val, had continued to spread in the Rue de TEscale, of which 
the Council of Health were informed about the 18th. A sur- 
geon, who was sent to examine into this matter, declared the 
disorder to be a worm fever. About the 23d the Council 
were informed of the death of no less than fourteen persons 
in that quarter, and of several others falling sick. The sur- 
geon adhered to his former opinion ; but a physician, who 
accompanied him at this visit, declared the distemper to be 
the plague. From this time the plague spread in different 
places, and by the end of the month had got into the sub- 
urbs. Four physicians were appointed to attend the infected, 
and all declared the disease to be the true plague ; but it 
having been hitherto confined chiefly to the lower class of 
people, the report of the physicians was not credited, their 
persons were insulted in the public streets, and the popular 
infatuation did not cease till some of the inhabitants of 
better rank were taken ill. After the first week of August 
the distemper increased rapidly, and universal dismay soon 
succeeded. 

" Such was the rise of the plague at first, and its progress 
afterwards in the months of June and July ; whence it ap- 
pears that persons on board the suspected ship, those em- 



IS IT CONTAGIOUS ? 59 

ployed in airing the goods, a surgeon and a priest who at- 
tended the sick, were among the first infected. That the 
passengers from the several ships, all of which ships, the 
first excepted, brought foul patents, were, together with 
their baggage, admitted into the city, after performing a 
quarantine of little more than eighteen days. That the dis- 
temper from the 20th of June till towards the end of July, 
advanced very slowly, and sometimes seemed to pause. That 
it attacked chiefly the poorer sort of people, and was found 
in distinct quarters of the city, but more particularly for 
some time among families inhabiting the Rue de l'Escale, 
where it broke out the beginning of July. And lastly, that 
during the first forty days, few or none of the infected re- 
covered ; a circumstance entirely consonant to what was 
observed in the beginning of the plague at Aleppo/' 

" The report transmitted to the Regent by M. Chicoyneau, 
the 18th of August, represents the physicians and surgeons 
as unanimous in their declaration, ' that when one person 
in a family was attacked and died, the rest soon underwent 
the same fate, insomuch that there were instances of fami- 
lies entirely destroyed in that manner ; and if any one of an 
infected family fled to another house, the contagion accom- 
panied him, and proved fatal to the family where he had 
taken refuge/ 

" The first hospital opened for the infected proved fatal to 
all the attendants. The introduction of the plague into the 
Hotel Dieu was traced to a woman received as a patient 
from the Rue de FEscale, the street where the distemper 
first broke out. Two of the nurses who assisted at her re- 
ception, and the matron who changed her linen, were taken 
ill next day, and died after a few hours' illness. From them 
the contagion spreading with dreadful rapidity, destroyed 
physicians, surgeons, apothecaries, confessors, and all the 



60 ON EPIDEMIC CHOLERA. 

other officers and servants of the house, with the whole of 
the poor in the hospital, including above three hundred 
foundlings. The priests and monks who attended the in- 
fected suffered in the same manner as the medical assistants, 
but many of them caught the infection by unguarded inter- 
course before the distemper was publicly avowed. Lastly, 
of two hundred and thirty galley-slaves, employed in going 
into the infected houses, and in burying the dead, two hun- 
dred and twenty perished in the space of ten or twelve days. 
It were superfluous to collect a greater number of particular 
instances, where the whole tenor of the history concurs to 
establish the fact in question/' 

The plague raged with great violence in August and Sep- 
tember, destroying sometimes 500 in one day. It declined 
as suddenly in October, and continued to lessen until it had 
almost entirely disappeared in January and February of 
1721. The number of inhabitants at the commencement of 
the plague, was reckoned at 90,000, and of those 40,000 are 
supposed to have died. As it declined in Marseilles, it 
spread into the surrounding country, which till then had 
been exempt. 

Would the plague have broken out at Marseilles had Cap- 
tain Chataud's fatal ship been wrecked on its way, and 
never reached the shores of France ? We are disposed to 
believe that it would not, if all communication with the 
East had been prevented. For even when the plague was 
raging in Marseilles itself, those who kept themselves strictly 
excluded, were not attacked by it. We have seen that it de- 
stroyed about one-half of the inhabitants, and yet we have the 
positive assertion of the Bishop of Marseilles, that " during 
the desolation of Marseilles in 1720 and 1721, the plague 
did not penetrate into the religious communities who had 
no communication with persons outside/' We are too good 



IS IT CONTAGIOUS ? 61 

Protestants to ascribe this exemption to any miraculous in- 
terference in behalf of the inmates on account of their 
superior sanctity ; and therefore can find no other reason 
than that they had no communication with those affected 
with plague. We must remember that at that period the 
number of " religieuses" in France was immense. It was 
before her expurgation — to use the term employed in de- 
scribing the clearing of a town from the plague. 

The exemption of the convents from the plague forms a 
contrast between it and the cholera, as we observed that one 
of the first cases of cholera at Moscow was in a convent ; as 
also the great tract of intermediate country which remained 
free of all infection. The plague follows the line of human 
intercourse, and when that line is in the sea, which cannot 
be infected by the troubles of man, it strikes root the mo- 
ment it touches land. It colonizes — going from port to port. 
It does not sweep over vast districts, like an inundation of 
barbarous hordes. 

Although the plague is undoubtedly a disease which re- 
quires human intercourse to spread it, yet that is not suffi- 
cient of itself. The fuel must be prepared, or the spark 
falls in vain. It spreads only at particular seasons, and in 
particular places. We have given an example of its arrival 
at a place where all was ready for its reception, and where 
its triumph was instantaneous. We shall now give one of 
its arrival at a. place where it made slow progress at first, 
and had difficulty in effecting a footing. This is the inter- 
mediate link between such a place as Marseilles and the 
rest of France, which at that time was not infected at all. 
Our example shall be the island of Cyprus,* in 1759. 

" In the month of April, 1759, a large Turkish vessel, laden 
at Alexandria, and bound for Constantinople, was wrecked 

* See the Map attached to this volume. 



62 ON EPIDEMIC CHOLERA. 

in her passage, not far from Cape BafFa. Of the crew who 
were saved, a great part happened to be infected with the 
plague ; which was first communicated to certain villages on 
the road to Limosal, and afterwards to that town itself. 

" Some of the sailors died in the villages. The rest, after 
a short stay at Limosal, proceeded to Larnaka ; where they 
remained only a few days till a vessel presented, in which 
they crossed over to Syria. None of them died in Larnaka ; 
though it was known that several actually had the plague. 

" The contagion spread with such rapidity at Limosal, 
that, in the month of June, upwards of four hundred persons 
were reckoned to have died of it. Many of the inhabitants 
fled to the neighbouring villages, and to the mountains, 
transporting the contagion along with them. But though 
the plague showed itself now and then in those parts where 
the fugitives had taken shelter, as well as in other inland 
villages which had intercourse with Limosal, yet it was only 
about BafFa, and near to Limosal, that it spread considerably. 
" The condition of Larnaka, at this period, was remark- 
able. It had received part of the infected crew from Lim- 
osal ; it had maintained a constant intercourse with the in- 
fected quarters of the island ; peasants and mule-drivers 
from those parts, with the pestilential sores on their bodies, 
were daily in the streets and markets ; and some of them 
died in the houses of Larnaka. On the 22d of May, a vessel 
arrived from Damietta, which put on shore some infected 
passengers and sailors, who lodged in the houses, and com- 
municated freely with the natives. Another Turkish vessel, 
from the same place, arrived some time after, with infected 
persons on board, one of whom died on landing at the Ma- 
rine. Notwithstanding this new importation, none of the 
inhabitants of Larnaka were known to have contracted the 
plague. The Europeans, from whom many of the above cir- 



IS IT CONTAGIOUS \ 63 

cumstances were, at the time, carefully kept secret, observed 
no precautions for their own safety ; while the natives con- 
soled themselves with a traditionary notion, that a plague 
which did not begin in December, was not to be dreaded. 

" During the hot months of July, August, and Septem- 
ber, little was heard of the plague, and it was generally 
supposed to be extinguished at Limosal as well as in the 
villages ; but the truth was, it had all along continued lurk- 
ing in those parts, showing itself only by starts, particularly 
at Baffa, Piscopi, and other villages on the western and 
southern sides of the island. 

" In the month of October, the plague increased in those 
parts where it had appeared in the spring, and soon after, 
broke out at Nicosia, to which place the annual fair of St. 
Demetrio had drawn a great concourse of people from most 
parts of the island. The magistrates of Nicosia endeavoured 
at first to conceal the nature of the distemper, under the 
name of a malignant fever ; and in December, when eight 
or ten died daily, the dead bodies were buried privately in 
the night, in order to prevent the inhabitants being alarmed 
by frequent funerals. But, towards the end of the year, 
matters became too serious for stratagems of this kind ; 
for the contagion, which had, some time before, got among 
the Greeks and Armenians, was now arrived at such a 
height, as on some days to carry off fifteen Christians ; 
which people, in number, bear a small proportion to the 
Mohammedans. 

" The Europeans at Larnaka, deceived for some time by 
false accounts from Nicosia, continued to walk about with- 
out apprehension ; and even when better informed, by let- 
ters from the Terra Santa convent, about the beginning of 
January, which clearly asserted the nature of the malady 
reigning in the capital, and which carried off between forty 



t)4 ON EPIDEMIC CHOLERA. 

and fifty persons daily, they still were inclined to doubt the 
intelligence, and to indulge ill-grounded hope : neglecting 
those precautions which, however salutary, must in some 
measure bring all commercial affairs to a stop. 

" Towards the end of January, the plague advanced so 
dreadfully at Nicosia, that the Mohammedans enjoined pub- 
lic processions and supplications : an expedient which, by 
bringing together a promiscuous crowd of people, served 
only to propagate the contagion more effectually. The Euro- 
peans at Larnaka now caught the alarm ; for the fugitives 
from Nicosia, exaggerating the scenes of calamity from 
which they had fled, spread terror wherever they came. 

"In the beginning of February, the distemper appeared 
among the Turks at the Marine, and soon after, at Lar- 
naka. The Europeans shut up. The daily burials soon in- 
creased to eight or ten ; and during February, never ex- 
ceeded twenty. In the month of March, the disease would 
appear to have been more malignant than at first, for few 
or none of the infected recovered. The daily funerals arose 
to twenty- five and thirty ; and many of the inhabitants fled 
to the mountains. 

" The distemper continued to rage at Larnaka all the 
month of April ; and spread, at the same time, over the 
island — penetrating even into the province of Carpass, a cir- 
cumstance not know r n to have ever happened before. At 
the Marine, the daily burials decreased, which was attri- 
buted to the flight of the wretched inhabitants ; many of 
whom, like those of Larnaka, abandoned their half-desolate 
houses, and sought refuge in the country." 

It committed such devastation over this country, that there 
were hardly hands enough left to gather in the harvest : 
giving a sad significance to the cypress-tree, which derives 
its name from the island. 



IS IT CONTAGIOUS? 60 

Had there been a Parliamentary Commission sent to Cyprus 
in the year ] 759 to ascertain whether the plague was an in- 
fectious disease, it might have reported in the negative ; and 
had it qualified its report by the adverbs there and then, it 
could have incurred no blame ; for, in some places at least, 
it hardly exhibited its contagious character. We may thus 
learn, no opinion upon the contagiousness of a disease is of 
any value beyond the time and place which afford the facts on 
which the opinion rests. Because the plague was not con- 
tagious at Cyprus, or but slightly so at one time, it did not 
thence follow it was not contagious at Aleppo or Marseilles. 
-Contagiousness is not an essential attribute of any disease ; 
it is an accident dependent upon many modifying causes. 

Let us now proceed to apply this lesson to the most im- 
portant question, of the contagiousness of cholera. Before 
investigating the evidence in favour of the cholera being 
contagious, we shall briefly advert to the opposite view of 
the case. In the Second Report of the Metropolitan Sani- 
tary Commission, p. 56, we meet with the following sen- 
tences : — 

" 1st, That the disease, as it has recently appeared in Per- 
sia, in Trebizond, and in Russia, is unchanged in its general 
character, i.e., from the former epidemic. 

" 2c?, That the more recent experience in Russia has led to 
the general abandonment of the theory of its propagation 
by contagion — a conclusion in which, after a full considera- 
tion of the evidence presented to us, we fully concur." 

We are naturally anxious to know what evidence was 
presented to Her Majesty's Commissioners, on which they 
founded the gratifying conclusion that cholera is not conta- 
gious. The evidence is from the following sources :— first, 
The despatch of Doctors Sapi and Borg to the Vice-Consul 
at Constantinople upon the disease, as observed by them at 



66 ON EPIDEMIC CHOLERA. 

Trebizond ; second, The report of the physicians appointed 
by the Swedish government to investigate the disease at 
Moscow ; third, and last, The opinion of Indian practitioners. 
Admitting the evidence derived from these places to be un- 
exceptionable, what is the only conclusion which it justi- 
fies ? Neither more nor less than this, that the cholera was 
not contagious in Turkey, Russia, and India. And the 
Commissioners have no right whatever to make the abstract 
assertion, that the cholera is not propagated by contagion. 

But it may be asked, How could these Commissioners get 
at any other evidence ? They could not bring the cholera 
here, and experiment on the effect of another latitude and 
another climate. We reply, that had already been done for 
them. If the cholera was quite unchanged in all its features 
when it reappeared in Russia and Turkey, is there any 
reason to suppose it will be changed when it appears here ? 
Unless the Commission had the clearest proof that there 
had been such a change in the climate and constitution of 
this country since 1832, as would necessarily modify the 
character of an epidemic like the cholera, and strip it of its 
contagious qualities, it was their bounden duty to investi- 
gate the evidence for and against the contagiousness of the 
disease in its former visitation. This were far more ger- 
mane to the matter than telling us it was not contagious in 
India. It is not so long since the cholera was here as that 
all who had to do with it then are now dead and not to be 
had as witnesses, and even were it so, there is ample con- 
temporary testimony on which a sound judgment may be 
founded. 

We propose now leading evidence to prove, that both in 
the former and recent epidemic, the cholera was contagious 
in Scotland, The Commissioners are not to blame for being 
ignorant of the contagion of the recent epidemic, but we 



IS IT CONTAGIOUS ? 67 

think they are to blame for rashly concluding that it would 
not be contagious. And what we most dislike, is their 
speaking about the demoralizing effects of the doctrine of 
contagion. Careful investigation and accurate conclusions 
are the morals of science. With the consequences which 
may flow from the discovery of truth, scientific inquirers, as 
such, have nothing to do. 

To return from this digression, we shall proceed at once 
to call our witnesses to prove that, in Scotland in 1832, the 
cholera was contagious ; and in doing so, we shall quote 
largely from an article that appeared in No. cxxxv. of the 
Edinburgh Medical and Surgical Journal, by Professor Simp- 
son of Edinburgh,* as we look upon it as a model of scien- 
tific investigation, worthy of the present renown of its author, 
which this and his other early labours show to be no less 
well earned than it is now far spread. 

" The Leith and London Smack Trusty arrived at London 
on the 19th of February, and after remaining in port for 
fourteen days, sailed again on the 4th March, with ten of a 
crew, including the captain and mate, and six passengers 
on board. In London, the cholera was then prevailing to a 
considerable extent, more particularly on the side of the river, 
and in the quarter connected with the shipping. — 1. On the 
morning of the 6th, the cook was attacked with cholera at 
sea, and died on the 7th. — 2. Another seaman complained of 
headache when the vessel was brought up in Leith roads (a 
distance of about 400 miles from London) on the evening of 
the 8th. This man assisted on the same night another of 
the crew and a cabin boy to pull ashore the six passengers, 
in the boat belonging to the smack. When he reached the 

* On the Evidence of the Occasional Contagious Propagation of Malignant 
Cholera, which is derived from cases of its direct importation into new localities 
by infected individuals. 



68 ON EPIDEMIC CHOLERA. 

harbour, however, he found himself so unwell as not to be 
able to return on board, and died of cholera next morning 
in the Leith Hospital at twelve o'clock. This was the second 
case of the disease observed in Leith, the first having oc- 
curred about a month previously in a man who had been 
visiting his infected relations at Musselburgh. — 3. The other 
sailor who landed with him was also obliged to remain on 
shore, and had an attack of cholera that night, but recovered. 
— 4. On the morning of the 9th, another of the crew of the 
smack was seized with vomiting and purging immediately 
after the preventive boat visited the smack in the roads ; — 
and the vessel having been ordered ten miles up the river to 
the quarantine station at St. Margaret's Hope, he w^as, when 
the vessel arrived there about five o'clock of the same even- 
ing, transferred to the hospital-ship Nymphe. The Nymphe 
(one of the old men-of-war employed as quarantine vessels 
in the station) had been previously cleared out as an hospital- 
ship to receive a suspicious case of cholera which had oc- 
curred on board one of the vessels under quarantine on the 
2d March, but this man had been discharged as well on the 
5th. At the time that the sailor from the Trusty was placed 
in the Nymphe, on the evening of the 9th March, the 
Nymphe had only two mariners left on board, who had 
volunteered to act as nurses. On the 11th, two other 
mariners were joined to these ; and on the 16th, a fifth was 
added. The sailor from the Trusty had a severe attack, but 
continued in life till the 16th. — 5. In the afternoon of the 
10th, a second sailor was transferred from the Trusty to the 
Nymphe, labouring under cholera. He recovered. — 6, 7. On 
the 11th, two new men were attacked, and sent to the 
Nymphe, both of whom died. One of them was a Leith 
porter, who had come on board the vessel in Leith roads, 
having returned with the boats which landed the passengers* 



IS IT CONTAGIOUS % 69 

He and the pilot (who had joined the smack near the mouth 
of the river in Dunbar Bay) having been found on board by 
the officers in the preventive boat, were obliged to proceed 
with the vessel to the quarantine station. This porter, Mur- 
ray, was cut off by the disease after an illness of only twelve 
hours' duration. — 8. On the 12th, another of the crew of the 
Trusty was attacked and transferred to the Nymphe, but 
recovered in the course of a few days. 

" Thus out of the w r hole crew of the Trusty, ten in number, 
one died of cholera at sea ; a second on shore at Leith ; a 
third remained there, but recovered ; a fourth, whose case 
proved afterwards fatal, sickened while the vessel lay in 
Leith roads. Three others were attacked in St. Margaret's 
Hope, and sent on board the Nymphe ; and of these three, 
one recovered and two died. The porter who joined the vessel 
at Leith also took the disease there, and died. The three 
remaining members of the crew, and the pilot, who came on 
board in Dunbar Bay, had each an attack of diarrhoea. 

" Of the five mariners who had acted as nurses to the crew 
of the Trusty on board the hospital-ship, one was attacked 
with cholera during the afternoon of the 15th, and died in less 
than twelve hours. On the 24th, another of them was attacked 
with nausea, vomiting, purging, and tenesmus, but recovered. 
On the morning of the 27th, a third is reported in the ship's 
journal as attacked with the premonitory symptoms of 
cholera ; but is entered as better on the 28th and 29th. On 
the evening of the day on which the third nurse was at- 
tacked, a sailor was sent on board the Nymphe from a second 
infected vessel that had arrived in the quarantine ground, 
but up to that day only the men of the Trusty had, with the 
exception formerly noticed, been on board of her as patients/' 

Dr. Simpson himself minutely inquired into the details of 
this case, and guarantees the accuracy of the statement. 



70 ON EPIDEMIC CHOLERA. 

The following instance is reported by Dr. Brewster, brother 
of the celebrated Sir David Brewster, and clergyman of the 
parish in which Ferryden and Boden are situated : — 

" The village of Ferryden is placed on the south bank of 
the South Esk, opposite to the town of Montrose, and con- 
tains about 700 inhabitants. The district of country in 
which it lies remained altogether free of cholera, when, 
in 1832, and the earlier months of 1833, the disease was 
prevailing in different parts of the kingdom. In the end 
of June 1833, the smack Eagle, from London, arrived at 
Montrose. Two cases of cholera had occurred amongst the 
crew during the passage from London, one soon after the 
smack left that port, and the other off Harwich. As soon 
as the vessel reached Montrose river, the crew dispersed to 
their several homes. One of them, Robert Findlay, an in- 
habitant of Ferryden, carried his clothes and bedding to 
his house there. A day or two afterwards, two children in 
the village, who were reported to have been seen tumbling 
during the preceding day on Findlay's mattress as it was 
laid out to the air, were seized with rapidly fatal cholera, 
and died on the 2d of July ; and this, it may be proper to 
remark, took place at a time w T hen the disease was con- 
sidered to have nearly or entirely disappeared from Scotland. 
On visiting Ferryden that day, Dr. Brewster found the 
mother of the two children labouring under a fatal attack of 
cholera. The malady subsequently spread through the vil- 
lage, but not rapidly ; and during the four weeks it con- 
tinued, it carried off twenty-seven out of the 700 inhabitants, 
or nearly one out of every twenty-seven of the residents. It 
appeared (Dr. Brewster observes in the communication with 
which I have been favoured) in different parts of the village 
in succession, and almost uniformly among the relatives, 
visitors, and neighbours of those who were previously af- 



Ifc: 



IS IT CONTAGIOUS \ 7l 

fected. Out of the few cases, he adds, which appeared in 
Montrose, two were relatives of the sick in Ferryden, whom 
they had gone to visit there, and were themselves seized with 
the disease after their return home. The inhabitants of the 
adjoining district of country in general carefully avoided all 
communication with Ferryden, and the disease only appeared 
in one other part of the parish, viz., in Boddin, a small village 
on the sea coast, nearly three miles south from Ferryden. 
Only two cases occurred in this locality, but these two afforded 
strong corroborative testimony of the contagious property of 
cholera. Margaret Stott, a young woman, an inhabitant of 
Boddin, went to visit her sister at Ferryden, and, upon re- 
turning to Boddin, was seized with the disease, and died in 
two days. Jean Pcterkin, an aged woman, who lived in the 
house adjoining to that of Stott, and who had not been out 
of the village, assisted, amongst other things, in putting 
Stott's body into the coffin, and afterwards washed her bed- 
ding. In the course of two or three days, she had a fatal 
attack of cholera. No other person (Dr. Brewster adds) in 
the village of Boddin, or in the parish, or in the surrounding 
district, with the exceptions now noticed, was affected by 
the disease." 

The next case rests also on Dr. Simpson's own authority: — 
" In the village of Bathgate, which contains a population 
of nearly 3000 inhabitants, and is situated in West Lothian, 
eighteen miles west from Edinburgh, on the great road be- 
tween that city and Glasgow, six cases of pestilential cholera 
occurred during the prevalence of the disease in Scotland — 
four of them in persons who came to the town from infected 
districts, and the two others in the female villagers who 
acted as nurses to these strangers. There were two impor- 
tations of the disease. 

" First, A middle-aged female stranger was allowed, 



72 m ON EriDEMIC CHOLERA. 

secretly and contrary to the orders of the Local Board of 
Health, to enter one of the lodging-houses within the out- 
skirts of the village, on the evening of the 20th April 1832. 
This woman had, as was afterwards ascertained, been for 
some time a resident in Glasgow, but she had gone two or 
three days previously to Edinburgh, (where the cholera was 
at that time prevailing,) in order to relieve some goods lying 
in a pawnbroker s shop. After having lodged in Edinburgh 
for either one or two nights, she set out again for Glasgow 
on the morning of that day on which she reached Bathgate. 
By the time she arrived at this latter place, she was already 
complaining of being unwell, having become indisposed upon 
the road ; but her state was not such as to alarm the lodg- 
ing-house keeper, or to prevent him admitting her. Having 
manifested, however, during the night, well marked symp- 
toms of cholera, her condition was early on the following 
morning reported by Mr. Dixon, surgeon to the Local Board 
of Health, who immediately adopted all the means necessary 
to prevent the spread of the disease, and sent a female, who 
had been eighteen months resident in the village, to attend 
her as a nurse. The stranger died on the night of the 22d 
April, after an illness of about forty hours. Next day the 
village nurse, after being engaged in washing the clothes of 
the deceased, was seized with all the most marked symptoms 
of malignant cholera. She recovered, however, after passing 
through a very severe attack of the disease. 

" No other cases of cholera were seen in the village till 
the evening of the 27th of April, when the second importa- 
tion of the disease took place in the persons of three female 
mendicants, who had, the second or third day previously, 
left Edinburgh, having been lodging there in Blackfriar's 
Wynd, where the disease was then prevailing. On the 25th 
they were in the immediate vicinity of, and probably visited 



IS IT CONTAGIOUS ? 73 

Newbridge, a small village at mid-distance between Edin- 
burgh and Bathgate, and in which cholera was perhaps 
more prevalent and fatal, proportionally to the number of 
inhabitants, than in any other locality in Scotland. That 
night (25th) they slept at the farm-house of Niddry Mains, 
and while there, either one or two of them complained of 
being unwell, so much so that they did not reach the village 
of Broxburn (which is only about a mile distant from the 
farm-house, and about two miles westward of Newbridge) 
till the afternoon or evening of the 26th. Mr. Andrew 
Millar, the son of the farmer at Niddry Mains, was obliged, 
as I am informed by Dr. Thomson of Broxburn, to come out 
of church on the following Sunday (the 29th) from sickness, 
followed by an r attack of diarrhoea and some vomiting, which 
continued for about two days. His father, who had been 
for some time in an infirm state of health, became suddenly 
much indisposed on the evening of the 4th May, had rice- 
water evacuations to a great extent during the night, w r ith 
much sickness and sense of sinking, and when seen by Dr. 
Thomson on the following morning, was evidently in the 
collapsed stage of cholera, and died that afternoon. These 
two cases of the Messrs. Millar were, as Dr. Thomson assures 
me, the only instances of the disease among the resident in- 
habitants of the extensive district in which he practises, 
with the exception of either one or two examples of persons 
who had been exposed to the disease in Edinburgh, and who 
had afterwards sickened at Broxburn. 

" But to return to the three mendicants. They took up 
their abode during the night of the 26th in a lodging-house 
at Broxburn, and endeavoured, as was afterwards confessed, 
to conceal the disease under which they were labouring. 
Next morning two of them presented such open and alarm- 
ing symptoms of cholera, that all of them, however inhu- 



74 ON EPIDEMIC CHOLERA. 

manely, were forced out by the lodging-house keeper, and 
after lying on the public road for several hours, they were, 
by the local authorities of the place, forwarded in an open 
cart to Bathgate, a distance of seven miles. By the time 
they reached Bathgate they were both in the stage of col- 
lapse, and were immediately placed in a room in the village 
jail, a somewhat isolated building, situated in almost the 
very centre of the town. The elder stranger sunk in thirty 
hours after her arrival, and the younger one, her foster- 
child, survived only for about twenty-four hours longer. 
Three female nurses, all natives, and resident in Bathgate, 
were engaged to attend these cases — a duty in which they 
were assisted by a niece of the elder stranger, who had 
accompanied her. One of these three town nurses was 
attacked with cholera on the morning of the 30th, the day 
on which the younger stranger died ; and she sunk under 
the disease in the course of about eighteen hours. On the 
same day also, the third remaining stranger, a girl of twenty, 
became affected with the disease, and died of the secondary 
head affection on the fourth day afterwards. Besides the 
four nurses that I have mentioned, there were also neces- 
sarily freely exposed to the contagion in Bathgate the land- 
lord and his wife to whom the lodging-house belonged in 
which the first patient died, and where her nurse was con- 
fined, as well as the four surgeons of the village, (one of 
whom lived with the patients as a nurse,) the clergyman of 
the parish, who was most assiduous in his attentions to the 
sick, and a man who frequently visited them and acted as 
porter to the hospital. None, however, of these or of the 
other inhabitants became affected with the disease, with the 
exception of the two nurses, and perhaps we may add, one 
of the surgeons, (Mr. Dickson,) who had an attack of tormina 
and diarrhoea. The villagers in general, under a salutary 



IS IT CONTAGIOUS? 75 

dread of the disease, avoided as carefully as possible all 
intercourse whatever with the infected persons and houses. 

" All the district and villages more immediately around 
Bathgate totally escaped any attack of cholera. The near- 
est point at which the disease is known to have occurred 
was at Linlithgow, which lies about seven miles to the north, 
where one or two suspicious but not decided cases were ob- 
served. Towards the east, Mr. Millar's of Niddry Mains, 
about eight miles distant ; and to the south, some cases 
to be afterwards mentioned, which occurred at Carnwath, 
ten or eleven miles distant, were, I believe, the nearest seen 
in these directions ; and on the west side the disease does 
not seem to have shown itself nearer than Clarkstone, a vil- 
lage thirteen miles distant, and in which it prevailed to a 
considerable extent. In this calculation, I do not of course 
include some instances in which the affection w r as observed 
in the passengers in the canal boats, and others who were 
passing through the district, or who came to it, after being 
already exposed in infected localities, and died without pro- 
pagating the disease. One or two such cases were seen by 
the medical men both of Linlithgow and Broxburn." 

Here, as in the case of the plague at Larnaka in Cyprus, 
the fuel was not then ready, and the disease appeared like 
a spark from a flint without tinder for it to fall on, a mo- 
ment incandescent, and straightway cold again. It may 
burn the hand of an individual, but cannot fire a village. j 

We shall conclude our extracts by the following, which 
enables us to bring forward the valuable authority of Pro- 
fessor Alison, who is celebrated alike for his wisdom and his 
goodness : — 

" Before cholera reached Edinburgh, it raged for some 
time previously in a severe degree in the district of country 
lying to the east of the city, as in Haddington, Tranent, 



76 ON EPIDEMIC CHOLERA. 

Prestonpans, &c., and particularly in the town of Mus- 
selburgh, six miles distant. The first cases of the disease 
which were observed in Edinburgh, occurred towards the 
latter end of January 1832, and were all in the persons of 
individuals who had been visiting some of the places to the 
eastward where the cholera was prevailing, and who had 
consequently been directly exposed to the morbific cause or 
causes of the malady (whatever we allow these to be) which 
were operating in these infected localities. The second case 
(27th January) afforded an instructive example of the great 
difficulty which is often experienced in endeavouring to 
arrive at the truth in such investigations as the present. 
The subject of the case, an Irishwoman, residing in a close 
off the West Bow, was taken to one of the cholera hospitals, 
and was for some time conceived to afford the strongest pos- 
sible evidence against the doctrine of contagion, for she 
stoutly denied having been out of Edinburgh. During 
the period of her convalescence, however, she voluntarily 
mentioned to Dr. Ransford, then clerk to the hospital, that 
she had been some days previously singing in the streets of 
Haddington, Tranent, and Musselburgh, and had slept at 
Prestonpans in the bed of a cholera patient ; and she stated 
that she had been before deterred from making this confes- 
sion, under the dread that she would be punished for bring- 
ing the disease into the town. 

"None of the three first cases of importation of cholera 
into the city proved effectual in propagating it to any of the 
resident inhabitants ; and no instance of a person being at- 
tacked with the malady, who had not been in the infected 
eastern districts, occurred till Saturday, the 28th of January, 
when a woman, Widow Macmillan, died of it in Skinner's 
Close, High Street, after nursing her grandson, who was 
previously ill of the disease, and had been exposed to its 



IS IT CONTAGIOUS ? 77 

contagion by residing in a house in Musselburgh, in which 
several fatal cases took place. Professor Alison has been so 
kind as draw up for me the history of these two cases, in as 
far as they bear upon the question of imported contagion ; 
and I shall here give the communication with which he has 
favoured me in his own words, and with his own excellent 
prefatory remarks and comments. 

" ' It seems to me clear/ he observes, ' that the evidence 
of the contagious nature of any disease turns ultimately on 
a calculation of chances. The question always comes to 
this, — Is the circumstance of intercourse with the sick fol- 
lowed by the appearance of the disease, in a proportion of 
cases so much greater than any other circumstance common 
to any portion of the inhabitants of the place under obser- 
vation, as to make it inconceivable that the succession of 
cases occurring in persons having that intercourse should 
have been the result of chance. If so, the inference is un- 
avoidable, that that intercourse must have acted as a cause 
of the disease. All observations which do not bear strictly 
on that point are irrelevant, and in the case of an epidemic 
first appearing in a town or district, a succession of tw r o 
cases is sometimes sufficient to furnish evidence, which, on 
the principle I have stated, is nearly irresistible. 

" ' For example, in the case of Widow Macmillan, in Skin- 
ner's Close, it is certain, as the whole town was under medi- 
cal surveillance at the time, and every one on the watch for 
cases of even suspicious cholera, that she was the first 
person in Edinburgh or Leith (i. e., in about 160,000 peo- 
ple) who took the disease without having been in the dis- 
trict at Musselburgh, Tranent, &c, where it prevailed ; nor 
was there any case in Edinburgh or Leith in a person who 
had not left the town for ten days after. And in regard to 
this first case of the disease in Mrs. Macmillan originating 



78 ON EPIDEMIC CHOLERA. 

in Edinburgh, the following points were ascertained by a 
judicial inquiry or precognition made, at the request of the 
Board of Health, by the Sheriff of the county, who examined 
different witnesses on each point till he was perfectly satis- 
fied of its truth. 1st, That the woman herself had never 
been out of the close in which she lived during the existence 
of the disease in the neighbourhood. 2d, That her son, a 
hawker, had slept in a house in Musselburgh, in which a 
woman was dying of the cholera, on the Monday. 3d, That 
after returning to' town, he was seized on Wednesday with 
vomiting and purging of whitish or watery matter, cramps, 
and feeble pulse. I saw this lad myself on that day, and 
immediately suspected that he had been at Musselburgh, 
which was at the time denied, but afterwards admitted, and 
confirmed by abundant other evidence. 4th, That Mrs. Mac- 
millan was with him during the day, in a small confined 
room, rubbing his limbs and nursing him, and he recovered 
under the use of opiates and stimulants. 5th, That on the 
Saturday, when he was convalescent, she was seized with 
the disease in its most virulent and unequivocal form, and 
died in ten hours. Now, I presume, it will not be denied 
that the epidemic cholera, which was never known in Edin- 
burgh before 1832, and has not been seen in it since 1833, 
must have some cause or causes of local and temporary ex- 
istence only. That the lad Macmillan, who had slept a 
night at Musselburgh, (then much affected with the disease,) 
should be seized with it, proves nothing as to the question, 
whether intercourse with the sick has the power of exciting 
the disease or not. But if that intercourse has no such 
power, it is plain that his mother, who never left her own 
close, had no more business to take the disease than any 
other of the inhabitants of Edinburgh or Leith, and her in- 
fection must have been a mere chance. The chances, there- 



IS IT CONTAGIONS? 79 

fore, are nearly 160,000 to 1 against her being the first per- 
son in Edinburgh or Leith who should take the disease, 
and almost infinite to one against her being infected by 
it within sixty hours after her son. 

" ' From the time, therefore/ Dr. Alison adds, c when I 
was satisfied as to these facts, I have never doubted of the 
disease having a contagious property, although I have never 
thought it proved that its extension is to be ascribed to that 
property alone/ " 

Such is a small portion of the evidence accumulated during 
the previous visitation of cholera, illustrating the contagious 
nature of the disease. We shall now mention some facts of 
a similar kind in respect to the present epidemic. 

Out of 183 cases treated by the physicians of the Edin- 
burgh Homoeopathic Dispensary, and scattered over the whole 
of Edinburgh, seventy-three were ascertained to have been 
exposed to contagion. That is more than a third of the whole 
number. 

" Since the 28th of October/' writes Dr. William Robert- 
son, in an excellent article upon the statistics of the Cholera 
Hospital in Edinburgh, over which he presided, " eighteen 
nurses have been employed at different times in the Cholera 
Hospital ; five of these have had severe attacks of cholera, 
and three have died. A sixth, who for twelve hours had 
frequent vomiting and purging, was treated as a cholera 
patient, and recovered ; yet, at the same time, a very large 
number of nurses were employed in the neighbouring build- 
ings of the Royal Infirmary, and escaped the disease. The 
circumstances, habits, and diet of both sets of nurses are the 
same. The work is not more severe in the Cholera Hospital 
than in the Infirmary. The arrangement for ventilation 
and cleanliness are not defective in Surgeon Square, (i.e., in 
Cholera Hospital) ; but for nearly two months past, no 



80 ON EPIDEMIC CHOLERA. 

cholera patients have been admitted into the Royal Infir- 
mary. In illustrating the contagiousness of typhus fever we 
are accustomed to regard evidence of this kind as tolerably 
conclusive/' 

There are numerous caves in the neighbourhood of Naples, 
into one of them, called the Grotto del Cane, if a dog be put 
it dies. It does not die if put into any of the others ; hence 
it is supposed that there is something peculiar in that grotto 
which kills the dog. There are two buildings in Surgeon 
Square, into both of which a number of women are put of 
the same class and character. The whole that enter one of 
the buildings come out as they went in. Nearly a third are 
smitten with a peculiar and fatal disease in the other build- 
ing. Hence it is supposed that there is something in the 
latter building which destroys these poor women. 

"We shall now descend from generalities to particular in- 
stances, and our first document is a letter from Mr. Moir of 
Musselburgh, (a gentleman well-known in the republic of let- 
ters, under the Nom de Guerre of J, and whose accuracy and 
veracity are beyond dispute,) to Mr. William Scot : — 

" INTRODUCTION AND SPREAD OF THE CHOLERA AT PRESTONPANS, 
KIRKLISTON, AND CARRINGTON. 

" Mosselburgh, 2d March, 1849. 

" My Dear Sir, — I promised to send you some corrobora- 
tive proofs of cholera being a contagious disease in Scotland, 
from a sketch of its introduction recently into some of the 
localities in this neighbourhood ; and I have selected Pres- 
tonpans for the purpose, from being fortunately enabled to 
obtain undoubted information regarding the first appearance 
of the disease there, and of the communication and consan- 
guinity subsisting between the original victims. 

" Without offering a word of comment, I subjoin a list of 



IS IT CONTAGIOUS ? 81 

the first twenty-three cases, as successively registered in 
the books of the inspector of poor for the parish, and which 
have been extracted for me by my friend, Dr. Thomas R. 
Scott. For the local information I am indebted to Mr. 
William Alexander, salt-manufacturer, a gentleman resident 
on the spot, and who took a prominent part in the enforce- 
ment of local sanitary measures. 

" Case I. — Grace Blyth, seized on the 24th November, 
died on the 25th. Returned from Gilmerton on the 23d, 
whither she had gone to visit a relation labouring under 
cholera there. 

" Case II. — Jane Gibb, seized on 6th December, died on 
8th. Washed the clothes of Grace Blyth on the day pre- 
vious to her own attack. 

" Case III. — George Mitchell, seized on 7th December, 
died same day. Lived in the house adjoining the two first 
cases, and had visited both. 

"Case IV. — Fanny Gibb, seized on the 8th December, 
died same day. Sister of Jane Gibb, and laid out her body 
after death. 

" Case V. — Widow Bartleman's child, seized on the 8th 
December, recovered. House adjoining the two others. 

" Case VI. — Mary Anne Gibb, seized on 10th December, 
and recovered. Niece of Jane and Fanny Gibb. She was 
in service at Musselburgh, and was sent for to nurse her re- 
latives. 

" Case VII. — Jane Troup, seized on 10th December, and 
recovered. The first six cases occurred at the western ex- 
tremity of the village. Jane Troup, who w T ent about collect- 
ing rags, got possession of some of the clothes of Fanny 
Gibb ; took them to her house in the centre of the village, 
(the Big Wynd,) and was attacked on the succeeding day. 



82 ON EPIDEMIC CHOLERA. 

" Case VIII. — Alexander Troup, seized on the 11th De- 
cember, and died on the 16th. Husband of Jane Troup. 

" Case IX. — Widow Bartleman, seized on 14th Decem- 
ber, died on 16th. Mother of (Case V.) 

" Case X. — Mrs. Fraser, seized on 14th December, and 
died on 15th. Attended Troup and his wife during their 
illness. Lived in adjoining house. 

" Case XL 

" Case XII. 

" Case XIII. — Two children of Mrs. Fraser were seized on 
the 14th December, shortly after their mother ; a third on 
the 15th ; and all three died on 16th. 

" Case XIV. — Elizabeth Notman, seized on the 15th 
December, died on 16th. Attended Jane Gibb and several 
others. Washed Gibb's clothes. 

" Case XV. — James Mackenzie, seized on 15th Decem- 
ber, and died on 16th. Lived in the upper flat of Troup's 
house, and visited the family repeatedly during their illness. 

" Case XVI. — Margaret Notman, seized on 16th, and died 
on 17th December. Daughter of Elizabeth Notman, (Case 
XIV.) 

" Case XVII. — James Cameron was seized on 17th De- 
cember, and died same day. Lived in house adjoining pre- 
vious cases. (XIV. XVI.) 

" Case XVIII. — Widow Crawford, seized on 17th Decem- 
ber, died on same day. House adjoining Troup's and Fra- 
ser's, both of which families she visited. 

" Case XIX. — Jean Deans was seized on 1 7th December, 
died same day. Aunt of Mrs. Fraser. 

" Case XX. — Margaret Gordon, seized on 1 7th December, 
and recovered. Sister-in-law of Jean Deans, and washed 
her clothes. 



IS IT CONTAGIOUS ? S3 

u Case XXI. — Jean Hunter, seized on lYth December, 
and recovered. Lived in house adjoining that of Blyth, the 
Gibbs, and Mitchell, at west end of the village, all of whom 
she visited during their illness. 

" Case XXII. — Janet Deans, seized on 17th December, 
recovered. Sister of Jean Deans. 

" Case XXIII. — Margaret Not man, seized on 19th De- 
cember, and recovered. Sister-in-law of Elizabeth Notman, 
(Case XIV.,) and mother-in-law of Mrs. Fraser, (Case X.) 

" The total number of cases which occurred at Preston - 
pans was fifty-two, and the deaths twenty-seven. As I 
challenge investigation of this statement, you, my dear Sir, 
may make any use of it you please, 

" Ever most truly yours, 

" WiUiam Scot, Esq. " D. M. MOIR," 

" P.S. — Since writing the above I have received the fol- 
lowing strongly confirmatory statements relating to neigh- 
bouring localities — Kirkliston and Carrington ; and I select 
them from among many others, which have been recently 
kindly forwarded to me, as comprehending the two great 
points at issue, in reference to the contagiousness or non- 
contagiousness of cholera — the importation of the disease 
from an infected district, and its spread from that importa- 
tion in a previously healthy one. The first series of cases 
has been furnished to me by my quondam pupil, Dr. Andrew 
Legat of Ratho ; the other series by Mr. Thomas Thomson, 
surgeon, Gorebridge, who also writes from personal obser- 
vation. 

" Up to Wednesday, 14th February, the parish of Kirklis- 
ton had kept perfectly free from cholera, when, at eleven 
o'clock on the evening of that day, an Irish labourer, John 
MacGochie, accompanied by his wife, arrived at the railway 



84 ON EPIDEMIC CHOLERA. 

station there. Both went to bed apparently well ; but, in a 
few hours, decided symptoms of the disease exhibited them- 
selves in the woman. They had come from Ambleside, via 
Kelso, an infected town, where they had slept on the night 
preceding. She died on the forenoon of Friday the 16th. 

" Case II. — Occurred in Ronald Gillies, a Highland la- 
bourer, who lodged in the second hut from MacGochie's — 
the door of which he had to pass in getting to his own, 
and many times did so between the Thursday and Saturday 
when he took ill. Was at work on last-mentioned day, 
16th, but had to come home. Died on Sunday, 1 7th, at 
nine, a.m. 

" Case III. — John MacGochie, the husband of Mary, 
(Case I.,) sat up with the body of his wife during the night 
of Friday 16th, and buried her on the following day, up to 
which time he felt well. Immediately after the funeral he 
went forward to Edinburgh, where he became ill, and was 
removed to the Cholera Hospital. He recovered. 

" Case IV. — The next person attacked was Miss Braid, 
the sister of Mr. Braid, surgeon. On Sunday morning her 
brother — who was by this time himself labouring under the 
premonitory symptoms — went directly home from the bed- 
side of Gillies, (Case II.,) on whom he was in attendance, to 
his own house, which is at the opposite extremity of the 
village, and remained beside her for a considerable time 
before again venturing out. She was seized in the course of 
the day, and died during the night following. 

" Case V. — Poor Mr. Braid himself was the next who fol- 
lowed. As already mentioned, he had been complaining for 
two days previously ; but it was not till Monday, 19th, at 
midnight, that cholera decidedly showed itself. At eight 
on the preceding evening he had assisted in placing the 
body of his sister in her coffin ; and, at that time, said, ' he 



IS IT CONTAGIOUS ? 85 

* felt he was in for cholera/ owing to some peculiar sen- 
sations. Death followed at eleven, a.m., on Tuesday the 
20th. 

" Case VI. — Occurred on Wednesday night, in a part of 
the village still more remote from the original sphere of in- 
fection. It was in the person of Mrs. Grindlay, the woman 
who acted as nurse to Mr. Braid. She also died. 

" Case VII. — Brings us back to the original locality. 
Mary Kerr, a woman inhabiting the house next MacGochie's, 
(Cases I. and III.,) was attacked early on the morning of 
Thursday the 2 2d. While in attendance on case first, Mr. 
Braid had come into her hut to rest, and he remained there 
for some time ; and she said she felt aware of a peculiar 
heavy smell about his person, which nauseated her. On that 
day she took bowel complaint, which, however, continued 
moderate until Thursday, 22d, when the disease assumed its 
more decided and virulent form. She recovered. 

" Case VIII. (and last.) — Was John Gillies, a brother of 
Case No. II., and who lived in the same house. After 
labouring under the premonitory symptoms for some days, 
the disease assumed its more decided form ; but he also re- 
covered. 

" As a preamble to the Carrington cases, communicated 
by Mr. Thomson, it seems necessary to state, that, while the 
pestilence was at its height in Glasgow, Mr. J n, a mer- 
cantile gentleman there, fell a victim to it. This happened 
to be a son of a respectable farmer in the parish of Libber- 
ton, adjacent to Edinburgh, who sent a brother of the de- 
ceased to bring home his remains for interment. This un- 
fortunate proceeding was followed by the seizure of two 
brothers and a sister, one of the former of whom died — the 
one who had brought the remains from Glasgow ; — and a 
servant girl having exhibited the premonitory symptoms, 



86 ON EPIDEMIC CHOLEEA. 

she was conveyed home to Ca*rington, a locality some eight 
or ten miles southward, hitherto unaffected. 

" Case I. — Janet Inglis, servant at Straiton, in the parish 
of Libberton, came home on the 8th January, labouring 
under symptoms of cholera. She recovered. 

" Case II. — Mrs. Inglis, her stepmother, was taken ill on 
13th, and died on 14th. Nursed her stepdaughter during 
her illness. 

" Case III. — Mrs. Lyell, aunt of Janet Inglis, was in at- 
tendance on both the preceding cases. She was seized on 
the 16th, and died on 19th. Her house was next door to 
that of Mrs. Inglis. 

" Case IV. (and last.) — James Inglis, father of Janet 
Inglis, (Case I.,) husband of Mrs. Inglis, (Case II.,) and 
brother of Mrs. Lyell, (Case III.,) was seized on the 16th, 
and recovered. 

" To the three sorites here succinctly given, I could add 
many more in my possession, connected with the recent re- 
introduction of cholera to Scotland from Hamburg. When, 
by the doctrine of chances, these are satisfactorily accounted 
for, the others shall be at the service of the public." 

We conclude with the following quotation from Dr. 
Muller's Report : — 

" On the 27th of May, the ship Ixion of Nicolajew, coming 
from an infected place, brought to Sevastopel several persons 
who had been attacked, among others an army surgeon Sp., 
who was removed to his own house. On the 29th, his ser- 
vant was taken ill ; on the 30th, his two daughters ; on the 
31st, a female relation who nursed him ; and on the same day, 
her two children ; upon this the disease spread more widely 
through the town. 

" Wollhynian department. The priest M. was attacked in 
the beginning of June, soon after his return from Kiew, 



IS IT CONTAGIOUS ? 87 

where the cholera prevailed, and died. A few days after, 
the woman who arranged the body was seized, and then her 
two children ; and so the disorder spread in Schitomir. 

" In Luga, an employe, who came from Petersburgh, was 
the first person attacked. 

" In St. Petersburgh, the first patient was a dean (on 4th 
June) who came from Novoi Ladoga, an infected place. The 
other early cases occurred on the great Neva ; they were 
boatmen in a wood boat from the infected district of Nov- 
gorod ; they were followed by two labourers belonging to 
another boat, next the ferrymen of the neighbourhood, and 
the labourers at the exchange. On the 7th June, occurred 
the first case among the inhabitants, in close proximity to 
the boats on the left bank of the Neva. 

" At Jamburg, the first patients were eight labourers who 
had come from St. Petersburgh. 

" At Rewal, also the first were two passengers who came 
from St. Petersburgh by the steamer of 24th June. Both of 
them died in the hospital, and thence the epidemic spread. 

"At Riga, the widow P. was attacked on the 19th June, 
having come from St. Petersburgh by the steamer, and also 
a cook of Count Siewer's from the same place. Not till three 
days after did there occur other cases there, two of persons 
from the same neighbourhood/' 

We had intended giving some such examples from our own 
experience as we have just quoted, but we believe it is quite 
unnecessary, until at least the evidence afforded by these be 
got rid of in some way or other ; but we may state it as the 
opinion of almost all with whom we have conversed on the 
subject, and who have had opportunities of forming a correct 
judgment, that intercourse with those ill of cholera increases 
the liability to the disease ; and therefore that in Scotland 
the cholera is certainly contagious. 



88 ON EPIDEMIC CHOLERA. 

Those who are the most unwilling to admit the contagious- 
ness of cholera, allow its tendency to " localize" itself, as they 
term it. That is, if cholera once gains access to a house, 
then all the inmates of that house, and all who enter it, 
become liable to be attacked by the disease. The fact is 
undoubted, and we have seen many instances of it ; some- 
times after the lapse of two weeks the poison continued to 
act upon a new comer. This naturally suggests the question, 
Where does the poison dwell ? The rooms are sometimes per- 
fectly bare ; not even are there bed-clothes to harbour the 
deadly and subtle power. The cholera does not seem to be 
readily conveyed by fames ; for it was observed that at the 
hemp and flax wharfs of Petersburgh, where wares were 
stored from many infected districts, the cholera did not ap- 
pear any sooner than in other parts of the city.* Does it 
dwell in the atmosphere ? That, we should think, must 
be frequently entirely renewed ; for with a window, a door, 
and a fire, there must be a rapid and total change of 
air. We cannot say where this morbific force resides. We 
might say it haunted a house, and there is no reason in the 
nature of things why it might not continue to haunt it for 
years as well as weeks. This is conceivable, and if it actually 
were to occur, it might give a hint to the ingenious specula- 
tors about ghosts, who have recently sought to revive many 
forgotten stories, and to advance into a place in history and 
science what hitherto belonged to the region of fable alone. 
Admitting as proved, which we are far from believing, that 
in certain places certain individuals see apparitions, we might 
imagine the phenomenon to be thus accounted for. That 
the human body in certain conditions can emit an influence 
capable of affecting others, and yet only to be detected by a 

* Document transmitted by Central Board of Health to the Privy Council, 
1832. 



IS IT CONTAGIOUS ? 89 

vital test, all must allow : and that this influence can dwell for 
weeks in a place, is also undoubtedly true. Suppose that a 
person is murdered, it is possible that in the terror and 
agony of his hour of horror he may generate a peculiar 
emanation from his person, which may linger in the place 
where the deed of death took place ; and it is equally pos- 
sible that certain delicately organized individuals, alive to all 
the finest influences which affect the nervous systems of per- 
sons so constituted, on entering the chamber where this ema- 
nation is, may become morbidly affected, and the specific form 
of morbid action may be a spectral illusion. If all this be 
admitted, then we shall have a good clue to many ghost-stories; 
and if it be not admitted, then we must be content to wait 
till the sun rises upon " the night side of nature/' In the 
meantime, we would advise any of our readers who are in- 
terested in idle speculations of this kind to read a very inge- 
nious and able article upon ghosts and ghost-seers which 
aj>peared in Number XVIII. of the North British Review. 



90 ON EPIDEMIC CHOLERA. 



CHAPTER III. 

ITS PATHOLOGY. 

In this Chapter we propose to discuss the predisposing, 
exciting, and proximate causes, and morbid anatomy of 
cholera ; reserving for the sequel the consideration of the 
symptoms or semeiology, as well as all that refers to the 
treatment or therapeutics of the disease. 

By " predisposing causes" we mean all those conditions 
of the body, whether natural or acquired, which render it 
peculiarly liable to the influence of the exciting causes of 
the disease — as, for example, sex and starvation. By " ex- 
citing/' all the causes external to the body which tend to 
give rise to this peculiar morbid action within it, as the 
state of the atmosphere, or intercourse with the infected ; 
and lastly, by " proximate cause," the morbid action itself, 
which, if unchecked, necessarily goes on to produce all the 
phenomena of the disease. 

The proximate cause is the first in a series of morbid 
actions. Without it there can be no cholera ; but the sub- 
sequent changes in the system may or may not go on. 
These secondary morbid actions, which are produced by the 
first proximate cause, become themselves in their turn the 
proximate cause of a second series of phenomena. As it 
is of great consequence that we should have distinct ideas 
on this subject, we shall quote a paragraph from Fletcher's 
Pathology to the point : — 



ITS PATHOLOGY. 91 

"With respect to the admission of a proximate cause, 
there is much less approach to unanimity ; and indeed the 
existence of such a cause is in the present day very gener- 
ally, but, as it appears to us, very injudiciously questioned. 
In nine cases out of ten, a medical man, called on to define 
a proximate cause of a disease, will reply that he knows of 
no distinction between this cause and the disease itself, and 
that, in his view of the matter, the terms are synonymous. 
But this is to confound all distinction between what is often 
hidden and what is always manifest, and implies a very 
inadequate conception of what constitutes, strictly speaking, 
a disease. A disease is analogous to a healthy function ; a 
proximate cause to the mechanism of that function. We 
may recognise the one without knowing anything about 
the other. If the discharge from the nostrils in catarrh, and 
the yellow colour of the skin and eyes in jaundice, be dis- 
tinct respectively from an inflammation of the Schneiderian 
membrane, and an obstruction of the biliary ducts whence 
these symptoms proceed ; if what a person, ignorant even of 
the existence of such a membrane, or such ducts, imme- 
diately perceives and recognises, be distinct from what a me- 
dical man arrives at only by study and observation ; if, in a 
word, semeiology and pathology be distinct sciences, a disease 
is not identical with a proximate cause, but something re- 
sulting from it, and separated from it by a very distinct line 
of demarcation* It bears nearly the same relation to a 
proximate cause which a shadow does to the substance which 
produces it ; and as the shadow is the immediate and evident 
effect of the interposition of this substance, so as to intercept 
the rays of light, whether the substance be obvious or not, 
so a disease is the immediate effect of its proximate cause, 
which, in like manner, may or may not be obvious ; in other 
words, it is merely an abstract term, by which we signify 



92 ON EPIDEMIC CHOLERA. 

certain phenomena, without any reference to their immediate 
origin."* 

The terms " predisposing/' " exciting/' and " proximate/' 
although technical in their character, and generally confined 
in their use to pathological language, express the conditions 
under which all complicated phenomena take place. For 
example, suppose a hay-stack burned down, and we were to 
investigate the various steps of the operation ; suppose we 
ascertained that some miscreant had soaked one part with 
turpentine, and thus had rendered it more liable to catch 
fire — this would be the predisposing cause of its combus- 
tion. Then suppose the fellow had lighted a large fire of 
shavings to the windward of the stack, and that the wind, 
laden with burning embers, had blown upon that part which 
had been prepared by the turpentine to catch fire readily, we 
should call that the exciting cause. Let us observe that we 
have purposely chosen a mixed cause to illustrate the mean- 
ing of exciting cause. The wind without the embers might 
have blown till it blew the haystack away altogether, but 
would never have set it on fire ; and the fire without the 
wind would have been as innocent as if it were in the bosom 
of Hecla. The wind and flame together combined to make 
the exciting cause. The exciting causes of disease are almost 
all of this character ; and we often cannot analyze the com- 
ponent parts, which, by their mixture, make an exciting 
cause. The meeting of the exciting cause, the fiery wind, 
with the predisposing cause, the inflammable hay, give rise 
to the combustion. But where is the place for the proxi- 
mate cause? Flames and combustion are not the same. 
The northern lights stream in flames along the sky where 
there is nothing to burn, and the flames of the will-of-the- 
wisp may be seen to play above the swamp, without at all 
*■ Elements of General Pathology, pp. 3, 4. 



ITS PATHOLOGY— PREDISPOSING CAUSES. 93 

tending to dry it up, much less to set it on fire. The com- 
bustion of our haystack means that there has been a rapid 
union of the oxygen of the air with the carbon and hydro- 
gen of the turpentine and hay. This chemical action, not 
cognizable by the senses, gives rise to the phenomenon of a 
brilliant light, attended with intense heat, which can be 
both seen and felt, and which, were we to carry out our 
illustration, would represent the disease as contradistinguish- 
ed from its proximate cause. 

To return from this digression to the consideration of the 
predisposing causes of cholera, the first that meets our eye 
is sex. According to the subjoined table, which corre- 
sponds in its results to the observations made at the Cholera 
Hospital in Edinburgh, the number of females attacked by 
the disease was nearly double the number of males. How- 
ever, let us observe that this table also shows that the great 
majority of both the sexes were grown up, and the difference 
in the liability of the men and women to the disease may de- 
pend upon a difference in the habits, rather than be attribut- 
able to the sex alone. We are inclined to this opinion, for we 
find the relation of the sexes in reference to cholera to be 
reversed in other parts of the world, and it is hardly likely 
that climate could effect such a change if it were depen- 
dent upon sex alone. For woman's character, although still 
" varium et mutabile semper" seems to be essentially the most 
unchangeable thing in nature. 

In India it appears that a larger proportion of women 
than of men were attacked by this disease. The proportion 
of males to females in the suburbs of Calcutta was, accord- 
ing to Mr. Jameson, as four to one ; in some other places as 
two to one ; and this observation is confirmed by Dr. Mar- 
shall in Ceylon, and Dr. Scott at Madras.* At Moscow, 

* Orton, op. cit., p 454. 



94 



ON EPIDEMIC CHOLERA. 



according to a table given by Markus,* the number of men 
treated in the extraordinary hospitals and houses for the 
reception of patients generally, was 1 724, and the number 
of women 909. This was exclusive of the military force, who 
had hospitals of their own. 

The reason of the greater proportion of women to men 
who have .taken cholera here, we naturally find in their hav- 
ing much more to do both with the dying and the dead. 
With a devotion characteristic of their sex, they are always 
found hanging over their sick friends, relatives, or neigh- 
bours, and it is women who arrange the bodies for interment. 
The difference in the number of the sexes attacked by the 
disease here thus becomes an argument in favour of its 
contagiousness. 

In regard to age as a predisposing cause, it has been ob- 
served, that infants at the breast d6 not seem liable to the 
disease, which coincides with our own observations. In the 
following table will be found the results afforded by the cases 
treated at the Homoeopathic Dispensary : — 

TABLE SHOWING THE RELATION OF AGE AND SEX TO THE NUMBERS 
ATTACKED AND TO THE MORTALITY. 



Age. 


Number of 
Patients. 


Deaths 


3 

o 

7 

5 

36 

9 


Recoveries. 


Per Centage of 
Deaths. 


8 

1 

9 

8 

54 

13 


m 

a 

to 


o 


* 

-a 

3 

1 

15 

5 


£ 

§ 

to 

4 
4 

21 
4 


I 

6 

7 

39 

8 


•a 
s 

to 

8 
12 
84 
15 


o 


1 


li 
§ 
to 

33^ 
25* 
20 
21A 




331 

20| 

22H 

28£ 


Below 10 years 
From 10 to 20 
From 20 to 50 
Above 50 years 


12 i 21 

16 24 

105 159 

19 , 32 


14 '33i 
19 |12i 
123 ;27£ 
23 38-^ 


Totals 


84 1152 236 


24 


33 


57 


60 119 179 |28f 


21« 


24/, 



The next predisposing causes we encounter are intemper- 
ance and destitution. With regard to the former, it has 

* Op, Cit. Appendix. 



ITS PATHOLOGY — PKEDISPOSING CAUSES 95 

been too much the practice in dealing with this as with 
other points connected with the cholera, to sacrifice rigorous 
truth to didactic effort. Were we to believe some well-mean- 
ing, but one-ideaed persons, we should conclude that total 
abstinence from stimulants would be nothing short of the 
harbinger of the millennium — that the cholera, as w r ell as 
most other diseases, was sent as a special scourge to drunk- 
ards, and that no quiet living, respectable member of a tem- 
perance society need be at all alarmed when the cry of 
cholera is raised. At the first glance this statement seems 
to be borne out by statistics, and the tables we subjoin go to 
its corroboration. But a more general consideration, and a 
more extensive survey of the whole subject, will greatly 
modify this conclusion. Let it be observed that intemper- 
ance implies many things — destitution, filth, a wretched 
dwelling, reckless exposure to disease, and improper food. 
We have seen a drunkard staggering over his dying wife, 
vainly attempting to raise her in the bed. That to these 
concomitants of drunkenness rather than to the state of the 
body directly produced by this hideous vice, are to be attri- 
buted the number of the intemperate who perish from 
cholera, seems proved by the simple fact, that in India the 
proportion attacked is in direct ratio to the poverty of the 
persons. It is a disease emphatically of the poor. This is 
well brought out in the following passage from Dr. Orton's 
able and interesting work : — 

" The clearest and most striking general observation 
which occurs regarding the prevalence of the disease in dif- 
ferent classes of people, is, that the higher ranks of society 
have been found in India to suffer less than the lower ; and 
this seems to hold good through all its branches, military as 
well as civil, native and European. If we could divide the 
population of India on this principle into two classes, in the 



96 ON EPIDEMIC CHOLERA. 

same manner as we have bisected the year, it is probable 
that we should find the less fortunate half affected in the 
same proportion to the rest, as are the six summer months 
compared with those in which the sun is on the other side 
of the line. Thus we constantly find that the officer suffers 
less than the soldier or the sepoy ; that the superior descrip- 
tion of troops, as the cavalry, &c, (who form the elite of the 
army,) suffer less than the infantry, and they again, greatly 
less than the hard-labouring and ill-fed camp follower. So 
also it is as constantly found that the brahmin (the supreme 
or priest-caste) and the sleek banian (merchant) suffer less 
than the ryot, who pays often as much as half the produce 
of his rice-fields to government for rent, and extorts from 
them a scanty subsistence under a burning sun ; and still 
more remarkably less than the poor outcast pariah, who car- 
ries a burthen ten miles, and returns the next day empty- 
handed, for fivepence sterling. 

" The greater prevalence of the disease among soldiers, 
both native and European, than their officers, has been from 
the first generally remarked. Thus during the first attack 
at Bellary, not an officer out of at least fifty at the station 
was attacked. In the severe attack of the 34th, not more 
than two slight cases occurred in a body of about thirty 
officers, whilst of the men, one in eight was admitted into 
hospital, and many died. In the first and very severe preva- 
lence of the disease in the field-force in the Dooab, (General 
Pritzler's,) not more than two or three attacks occurred 
among the officers of the whole camp. In the Candeish field- 
force not one, though one of the corps suffered severely. 

" In the centre division of the Bengal army, too, Mr. 
Jameson states : — ' During the week in which the epidemic 
raged with so much fury, when the camp was a sick-ward, 
and every tent was filled or surrounded with the dead or 



ITS PATHOLOGY — PREDISPOSING CAUSES. 97 

dying, the officers suffered comparatively very little. From a 
number that could hardly have fallen short of three hundred, 
only five or six deaths occurred ; and it should be remem- 
bered, that at this time officers of all descriptions were 
equally exposed with the medical men, for the sick had be- 
come so numerous, that even the services of all were insuffi- 
cient to tend them with proper care, and duly administer 
the requisite remedies/ Mr. Marshall states, that in his ex- 
perience (in Ceylon) the commissioned officers were entirely 
exempted. 

" In this circumstance, however, there is nothing peculiar 
to cholera. Commissioned officers are generally much more 
healthy than at least European soldiers. This is particularly 
remarkable with regard to the dysentery, or the particular 
inflammation of the large intestines, which destroys probably 
at least one-half of the Europeans who die in India in ordi- 
nary times, and in those parts where malaria does not exist 
in any notable degree, a still larger proportion. From this 
disease officers are almost exempt, even when it is prevailing 
as a most virulent epidemic, as it often does in standing 
camps in hot weather. I have treated thousands of cases of 
it in soldiers, in these and all other usual situations, but 
never saw an officer die of it, and rarely a serious case, or an 
attack of it at all among them. This I have never ceased to 
wonder at, and in seeking its explanation, have sometimes 
been tempted to refer the disease to contagion. They 
are not so remarkably exempt from hepatitis. It is, how- 
ever, chiefly referrible to the greater regularity of life of 
the officer; for though he takes a considerable portion of 
spirituous fluids, it is regularly and without inducing intoxi- 
cation, whilst the soldier will be partially intoxicated for a 
week or two together ; and then, having no longer the power 
of inducing that state — which is with him the summurn bo- 
te 



98 ON EPIDEMIC CHOLERA. 

num, he reverts to his water-drinking till the next receipt 
of pay, or till he has hoarded up the means of renewing the 
excessive stimulus. The prospect of sickness, or even death, 
have no terrors for him to keep in check this inordinate ap- 
petite. And to this circumstance we must chiefly refer the 
greater prevalence of cholera in the European soldier than 
the officer. The former is sufficiently clothed and fed, and 
his frame is generally somewhat robust ; there is, therefore, 
no predisponent debility to account for it. Other circumstan- 
ces also, doubtless, contribute to produce the superior general 
healthiness of the officer, as his greater general care of his 
health and attention to its first derangements ; and particu- 
larly the greater influence of mind, and the amusement which 
it creates ; for ennui and inactivity of mind, as well as of 
body, are a great cause of disease, and nowhere so remark- 
ably as in hot climates. 

" The greater prevalence of the disease among the sepoys 
than their European officers, which is as remarkable as in 
the other case, is to be placed to another account. They are 
perfectly temperate, as are almost all the natives of India, 
but this temperance is with many of them perforce carried to 
excess. It is evident that the greater liability to this epi- 
demic of the sepoy than his officer, and indeed of the natives 
in general, compared with the Europeans in India, is owing 
to a diet not sufficiently nutritious to ward off the attacks of 
a disease which is so eminently one of debility, although it is 
undoubtedly better calculated than ours to obviate the com- 
moner form of Indian disease, pure inflammation. The pay 
of the sepoy is about fivepence per day, and on this most of 
them have families as well as themselves to maintain. Yet 
this is affluence compared with the situation of most of the 
inferior servants, grooms, tent-men, porters, &c, who receive 
not more than from half to two-thirds of that sum ; and they 



ITS PATHOLOGY — PREDISPOSING CAUSES. 



99 



again are objects of envy to others unemployed and still 
lower in the scale. Neither are the prices of the necessaries 
of life proportionably low. The general diet of the lower 
classes is rice or other grains, boiled whole or made into 
cakes, the insipidity of which is in some degree removed by a 
sort of thick soup composed of vegetables, and a great propor- 
tion of condiments ; and this food is too often also deficient 
in quantity. No wonder therefore that we should find so 
abundant a predisposition to the disease existing among a 
people thus dieted, and that it should be so often excited 
into action by exposure to cold and moisture in their 
wretched huts, or the still more wretched substitutes for 
tents of the innumerable followers of a camp/' 

We have attempted in the following table to distinguish 
between the drunken and the destitute — that is to say, 
those registered as destitute and dirty were not drunken, 
although it may be presumed that the intemperate were for 
the most part neither cleanly nor well fed. 

TABLE SHOWING THE HABITS AND CONDITION OP THE PATIENTS, AND THE 
EFFECT OF THESE CIRCUMSTANCES ON THE MORTALITY. 



j Habits : 

! Temperate 

I Intemperate 

! Condition : 

: Destitute and Dirty. 

! Comfortable 



Total. 


Deaths. 


Recov- 
eries. 


P. Cent, 

of 
Deaths. 


183 
53 


38 
19 


145 
34 


20 
35 


98 
138 


33 
24 


65 
114 


33 
17 



The return from the Cholera Hospital of Edinburgh does 
not altogether tally with this ; but we must recollect that 
the great majority of those who go to an hospital are intem- 
perate in their habits ; and we should require to know the 
proportion of temperate to intemperate in the Royal Infir- 



100 ON EPIDEMIC CHOLERA. 

mary, or some other larger hospital, before we could come to 
any legitimate conclusion upon the matter. 



Males. Females. Total. 



Dissipated : 37 39 ! 76 j 

Irregular 13 i 39 52 | 

Doubtful 2 19 21 

Sober 43 j 55 98 , 

Unknown 10 1 

The next predisposing cause we shall advert to is gastro- 
intestinal disorder, more especially diarrhoea. By the 
universal consent of all writers, there is a prevalence of 
diarrhoea about the time of the cholera epidemic. This de- 
rangement has been considered of so much importance by 
the Sanitary Commission, that they have gone the length 
of calling it the first stage of cholera. As this is a point of 
deep practical interest, lest we should in any way misstate 
the doctrines inculcated by the Commissioners, we shall 
quote at length from their Report : — 

" The whole tenor of that evidence shows, that the pre- 
monitory symptom of an attack of Asiatic cholera is loose- 
ness of the bowels. This may be accompanied with pain in 
the bowels, or it may be entirely without pain. The loose- 
ness itself may vary from one to three, six or more addi- 
tional evacuations daily. The evacuations at this period are 
generally faecal, and of their natural colour and odour, alto- 
gether unlike the discharges at the more advanced stage, 
when they are rice-coloured, and without their natural odour. 
The pain, if any is present, consists merely of the sensation 
of griping or uneasiness in the bowels ; but the discharges, 
even when accompanied by this uneasy sensation, produce so 
little inconvenience, that it is difficult to regard them as in- 
dications of illness, much less as the commencement of so 
terrible a malady. Yet this is the real beginning of the dis- 






ITS PATHOLOGY— PREDISPOSING CAUSES. 101 

ease, which consists of two stages — first, of this, the stage of 
simple diarrhoea ; and secondly, of the stage of collapse, or 
blue stage, to which alone the name of the disease, Asiatic 
Cholera, is commonly applied, all the symptoms character- 
istic of the malady being present only in this stage. 

" The first stage, or that of simple diarrhoea, may con- 
tinue from a few hours to two, three, or more days. If pro- 
per remedies are employed at this period, the progress of the 
disease is generally and easily checked, and the second stage 
never comes on ; but if neglected, the second stage com- 
mences suddenly, with all the violence which distinguishes 
this dreadful malady. But this suddenness is merely appa- 
rent ; the disease has been actually present, and has been 
making progress several hours, perhaps days, and it is the 
second, the violent, the unmanageable, and mortal stage that 
has really come on suddenly. 

" Any deviation, then, on the side of looseness, from the 
natural state of the bowels, during the prevalence of Asiatic 
cholera, is the real commencement of that disease ; a single 
additional evacuation daily, beyond what is natural to the 
constitution, nay, even a looser state of the daily evacuation 
must, under such circumstances, be so regarded. 

" Asiatic cholera appears to be caused by a poison diffused 
in the atmosphere, which acts with peculiar intensity on the 
mucous membrane of the alimentary canal. The irritation 
set up in this membrane, in most cases, is not violent at 
first ; but if it be allowed to continue unchecked many hours, 
it produces such an extraordinary change in the membrane, 
that the thinner and colourless portion of the blood is poured 
out from it with the same rapidity as it would be if a large 
opening were made in the great vein of the arm. 

" Mr. Hodgson of Birmingham, who has paid great atten- 
tion to this subject, and who on his examination drew our 



102 ON EPIDEMIC CHOLERA. 

attention in a special manner to the important consideration 
of the means by which cholera may be arrested in its first 
or premonitory stage, speaking of persons in the second 
stage, says : — 

" ' The immense discharge of serum from the blood reduces 
them to such a degree that they rarely rally. To expect 
them to rally is like expecting a patient to rally in whom a 
great blood-vessel has been opened, and from whom nearly 
all the blood of the body has been drained : the material of 
life has been taken away to such an extent that few only 
can sustain it/ 

" The view which we have now presented, of the import- 
ance of attending to the very first stage of this process, the 
commencement of which is indicated by any increase beyond 
the natural discharge from the alimentary canal, is in per- 
fect accordance with Indian opinion and practice. 

" ' It is,' says Dr. Parkes, ' the universal practice in the 
Indian army, immediately on the occurrence of cases of 
cholera, to issue orders directing the attention of the non- 
commissioned officers and men to the importance of attend- 
ing to any deviation from the ordinary health, and particu- 
larly to any symptom of bowel complaint ; and it is a 
positive order that any man so affected should report himself 
sick. It is always found that many men at such times do, 
in accordance with this order, report themselves sick, prov- 
ing the prevalence of such complaints. Many men, however, 
do not conform to this order, the affection being often so 
slight and so entirely without pain, that they cannot be in- 
duced to regard so apparently trifling an ailment as disease ; 
hence of the men admitted into hospital, many when seen 
for the first time present the developed stage of the disease. 
In the great majority of cases, there can be no doubt that 
this first stage indicated by this premonitory symptom does 



ITS PATHOLOGY— PREDISPOSING CAUSES. 1 03 

oxist. I witnessed two epidemics, the first, the slightest, in 
which the premonitory symptom was almost universal. In 
the second, the disease was more rapid, and appeared in some 
cases to present itself at once in its developed stage. These 
cases, however, even in India, appear to form an exceedingly 
small minority. 

" ' With regard to the duration of the premonitory stage in 
India, I do not think I ever myself witnessed a case in which 
the diarrhoea had existed longer than four days, and the 
usual time would in general be only a few hours ; that, how- 
ever, would aiford sufficient time for the application of reme- 
dies, capable, in the great majority of cases, of preventing the 
further progress of the disease/ 

" The opinion and practice of Russian physicians at the 
present time are in perfect accordance with their views. In 
all the accounts that we have recently received, the medical 
men who are treating the ej)idemic which is now prevailing, 
first and prominently urge, ' That the greatest attention 
must be paid to the diarrhcea/ which they say, ' precedes 

CHOLERA.' 

" From advices which we have just received from Con- 
stantinople, we learn that diarrhoea was prevalent and severe 
in Trebizond during the whole month of August, before 
cholera broke out in its Asiatic form early in September, 
and that in those persons in whom the disease advanced to 
this latter stage, diarrhoea was an early and prominent 
symptom. 

" It is notorious that diarrhoea was extremely prevalent 
in all the towns of the United Kingdom in which Asiatic 
cholera broke out in 1832, though at that time the observa- 
tion had not been clearly and generally made that it con- 
stantly precedes an attack, and is in fact the actual com- 
mencement of the disease. In the detailed accounts of par- 



104 ON EPIDEMIC CHOLERA. 

ticular cases occasionally transmitted from the Local Boards 
to the Central Board of Health, constant mention is made of 
the presence of diarrhoea, often two or three days before the 
violent attack came on. But, perhaps, one of the most in- 
teresting and instructive illustrations of the extent to which 
this premonitory system is present in a population in which 
cholera is prevalent, is afforded by the remarkable history of 
the progress and termination of this epidemic at Bilston and 
the neighbouring district in 1832. This pestilence raged in 
Bilston with greater violence than in any other part of the 
United Kingdom. Out of 14,700 inhabitants, 3568 were 
attacked with cholera, out of whom 792 died in less than 
seven weeks ; that is, one-fourth of the whole population were 
subjects of the disease, and one-fifth part of those attacked 
died. 

"The Rev. William Leigh, the enlightened and benevo- 
lent clergyman of Bilston, whose exertions to mitigate the 
sufferings of his parishioners during this melancholy visita- 
tion were most exemplary and indefatigable, gives the fol- 
lowing description of their condition : — 

" ' The pestilence/ he says, ' continues its ravages amongst 
us in a frightful manner. Our necessities are increasing 
every hour, and our resources are fast failing us. Three 
hundred pounds have been granted to the Board of Health 
out of the poor-rates ; but this sum will not pay for the 
coffins of the dead. All kind of business is at a stand. No- 
thing reigns here but want and disease — death and desola- 
tion. Two of our medical men have perished ; two more 
have left the place to recruit their exhausted strength ; and 
my respectable neighbours are nearly worn out by mental 
anxiety and exertion. I have been confined to my house 
since last Thursday, and nearly the whole of that time to 
my bed/ 



ITS PATHOLOGY — PREDISPOSING CAUSES. 105 

" In this extremity, the inhabitants applied to the Privy 
Council for medical aid, and Dr. M c Cann, who had seen much 
of cholera in India, was sent to their relief. The first thing 
he did was to open a dispensary, to secure the attendance of 
medical men there night and day, and to placard the town 
with notices, that whoever was attacked with looseness of the 
bowels, might receive gratuitously, at this institution, instant 
advice and relief. Two assistant surgeons, paid by the Board 
of Health, were in constant attendance, and the resident 
surgeons of the town, three in number, undertook to visit 
the institution daily at regular intervals. The dispensary 
was opened on the 26th of August ; on the following day, 
270 persons applied for relief for bowel complaints ; and in 
the course of eight days, the number increased to 1100, all 
of whom, on their personal application, received the appro- 
priate remedies for such complaints at the institution. The 
effect was most striking ; for it appears from the official 
Report of Dr. M'Cann, that in the course of a single week, 
the mortality was reduced one-half. 

" ' I have/ he says, ' the satisfaction to state, that the mor- 
tality in Bilston parish from cholera has been reduced during 
the last week to less than one-half what it was during the 
preceding ; the number of deaths from that disease during 
those two periods respectively, as taken from the burial re- 
gisters, has been as follows : — 

;< ' From 20th to 26th August, . . 275 

" ' From 27th August to 2d September, . 132 

" ' For this happy change, and happy it is comparatively, 
we are, I have no doubt, mainly indebted to the beneficial 
influence of the Public Dispensary for the Bowel Com- 
plaints, upw T ards of 1100 personal applications having been 
made and attended to at that institution, for such affections, 
during the last eight days. From this fact, the public may 



106 ON EPIDEMIC CHOLERA. 

at once perceive the extent to which disease, a disease, too, 
connected with cholera, prevails in this district, and at the 
same time be enabled to form some accurate notions of the 
advantages to be derived from placing within reach of the 
poor the means of obtaining prompt and proper relief for 
bowel complaints in times like the present ; for I have no 
hesitation in saying, that a large proportion of the cases 
above alluded to, w r ould, under existing circumstances here, 
have passed into cholera if neglected ; and that, of the cho- 
lerics, a large proportion would have died. In all places, 
therefore, where cholera prevails, or when it is expected, I 
would again, as I have repeatedly done before, exhort the 
local authorities to establish, without delay, public dispen- 
saries, where the poor, without trouble, or favour, or expense, 
may receive prompt and effectual treatment for bowel com- 
plaints. It cannot, indeed, be too often repeated, that loose- 
ness of the bowels is the beginning of cholera, and that such 
looseness admits of an easy and effectual cure, whilst cholera 
itself, or that stage of the disease in which vomiting, and 
cramps, and prostration, are added, or succeed to looseness, 
is one of the most fatal and intractable diseases known/ 
" The following week, Dr. M'Cann reports : — 
" c I have again the satisfaction to announce a remarkable 
decrease in the mortality at this place from cholera: the 
number of deaths from that disease, in this parish, during 
the week which has just terminated from the 3d to the 9th 
instant, (both inclusive,) having been only forty-four, or one- 
third of the number (132) which had taken place during the 
preceding seven days. The number of applicants at the 
dispensary also (new cases) for relief for bowel complaints 
has undergone a sensible diminution during the last few 
days ; but the daily average for the past week (upwards of 
130) is sufficient to show that the epidemic influence still 



ITS PATHOLOGY — PREDISPOSING CAUSES. 107 

prevails amongst us, and to a much greater extent than the 
cholera reports, taken independently, would seem to indicate. 
We have here, therefore, a new proof or illustration of the good 
effects resulting from such institutions ; for although renewed 
and indefatigable efforts have been made here during the 
past week to relieve the wants and add to the comforts of 
the poor in other respects, yet no one practically conversant 
with the subject can doubt but that all those efforts must 
have proved, in a great measure, unavailing towards arrest- 
ing the progress of the pestilence, if measures had not, at 
the same time, been adopted to extinguish, as it were, in 
each individual, according as he became affected, the seeds 
of that cruel malady/ 

" In nine days from this period, namely, the 19th of Sep- 
tember, the epidemic was extinguished, and on the same day 
the Bilston Board of Health addressed the following letter 
to the Privy Council : — 

" 'Board of Health, Sept 19. 

" c The Board of Health are anxious to convey to the 
Lords of the Council their grateful acknowledgments for the 
important and valuable services rendered to the township by 
Dr. M'Cann during his sojourn among them. To his un- 
wearied diligence in the discharge of his arduous and peril- 
ous duties, to his humane and unremitting attention to the 
poor, and above all, to his wise and salutary arrangements for 
arresting the progress of cholera in Bilston, the Board feel 
that, under God, they owe in a great degree the present 
favourable change in the condition of the inhabitants ; and 
so fully are the Board convinced of this, that they cannot 
refrain from expressing most respectfully their anxious hope 
that measures may be adopted, under the sanction of their 
lordships, for carrying into effect in other places where the 
pestilence may unhappily prevail, or where its approach may 



108 ON EPIDEMIC OHOLEJJA. 

be apprehended, similar arrangements to those from which 
they themselves, under God's good providence, have derived 
such signal advantages. 

(Signed) " ' W. Leigh, Chairman.' 

"By similar means, under the same superintendence, a 
similar result was produced at Wolverhampton, where cholera 
was prevailing very extensively at the time that Bilston ob- 
tained this ' melancholy pre-eminence in suffering/ 

" Of the correctness of this account we have received the 
following confirmation from Mr. Nicholas M'Cann, who 
states: — That he is a surgeon, and resides in Parliament 
Street, and that Dr. Francis M'Cann, who went down to 
Bilston, is deceased, and was a relative of his. He died two 
years ago. He had been in India, and was well versed in 
the treatment of cholera. 

" ' I was perfectly familiar/ continues this witness, ' with 
his treatment at the time, and adopted it. Whenever I was 
called in early enough to take advantage of the premonitory 
symptoms, I usually found his treatment successful, never 
once losing a patient. In the police division, which was under 
my care, I scarcely lost a man ; the order being from me for 
an early application upon any disordered or relaxed state of 
the bowels. Some certainly were lost, where the premoni- 
tory stage was not taken advantage of, according to the plan 
of treatment I pursued. At the period cholera made its first 
appearance in Westminster, in the years 1831 and 1832, the 
opportunity then afforded me was extensive, being connected 
with the largest and only dispensary in the neighbourhood 
of Parliament Street, and also being surgeon to the metro- 
politan police. 

" l From my own observation and experience, I have ar- 
rived at the conclusion that in ninety-nine cases out of every 
hundred, the premonitory symptoms (in other words, diar- 



ITS PATHOLOGY — PREDISPOSING CAUSES. 109 

rhoea) precede each and every attack, showing the necessity 
of making the earliest application for medical aid, and the 
great danger the patient incurs in neglecting such a neces- 
sary precaution/ 

" Mr. Hodgson, one of the two medical officers appointed 
by the Government on the Board of Health at Birmingham, 
states, that in consequence of his connexion with the Cholera 
Board, he paid great attention at the time to all the circum- 
stances connected with the disease ; that — 

" ' The disease raged very much at Bilston, and went on 
to a frightful extent, till the Government sent down to Bil- 
ston Dr. M'Cann, who had seen a good deal of the cholera 
in India, and I believe, in Persia. When Dr. M'Cann came 
to Bilston, he formed a cholera dispensary, or dispensary for 
bowel complaints, and drew r attention very strongly to the 
importance of attending to the premonitory condition. He 
told me, and almost everybody whom I have talked with who 
knows anything about the subject confirms it, that they never 
knew an instance of any person who had the second stage, 
who had not the premonitory stage, perhaps only to a slight 
degree. I remember hearing of some ladies being attacked 
who were out at a party one evening, one of whom was dead 
the next day : but even in those instances, if you could learn 
the particulars, you would find, I believe, that there has 
been the premonitory stage of diarrhoea to a greater or less 
extent/ " 

In order to establish the proposition that diarrhoea is the 
first stage of cholera, it must be shown either that it is 
always observed to be present, or that its absence can, in 
some way or other, be satisfactorily accounted for. If a pre- 
vious diarrhoea be an essential part of cholera, and it must 
be granted that a disease is not perfect, if it have not its 
first stage, then we should expect to find that those excep- 



110 OK EPIDEMIC CHOLERA. 

tional cases in which the diarrhoea was absent, presented an 
abortive form of the complaint. To induce us to call it the 
first stage, it must be very constant. If in a very consider- 
able number of cases it is absent, then we are not entitled to 
look upon it as essentially related to the cholera. If it 
were a very unusual phenomenon, then indeed from its fre- 
quent attendance upon cholera, and cholera alone, we might 
be inclined to consider them as very closely allied. If it 
never preceded any other disease except cholera, the evi- 
dence in favour of the views just stated would rise in value. 
Lastly, if there were no other plausible explanation of its 
occurrence, except as a part of the cholera, we might throw 
the blame of it upon this epidemic for want of something else. 

Is diarrhoea a constant attendant or precursor of cholera ? 
and when absent, does cholera appear in a modified form ? 
These two questions we shall answer simultaneously by giving 
a few individual cases when the absence of the diarrhoea was 
certain ; then some examples of large bodies of men who 
seem to have had cholera without having previously had 
diarrhoea ; thirdly, the general testimony of practitioners in 
India ; and lastly, the statistical returns afforded by our own 
observations. 

Our first example shall be that of a physician who was fami- 
liar with all the symptoms of cholera. Dr. Quin* thus de- 
scribes his own seizure, — " I was suddenly attacked by cholera 
during dinner, without any premonitory symptoms. I fell 
down senseless/' After describing the effects of the remedy 
he took, which mitigated the symptoms, he says, " I had no 
diarrhoea, although at every instant the violent cholicky 
pain made me think it was going to come." 

The two following cases occurred in our own practice, and 
we made particular inquiries whether there had not been some 

* Du Traitement Homoeopath ique du Cholera, p. 52. 



ITS PATHOLOGY — PREDISPOSING CAUSES. 1 1 1 

diarrhoea or gastro-intestinal derangement ; for our opinion 
at the time we saw them was quite unformed upon this point, 
and we were anxious for any facts which bore upon it. 
They may be taken as specimens of the cases entered in the 
table which we shall afterwards give, as " without gastro- 
intestinal disarrangement/' — 

" P. M., aged 46, a man of intemperate habits, living in a 
close room, with several other persons of both sexes, in a 
filthy lane of the Grassmarket, had been in his usual health, 
and had no diarrhoea till 5 o'clock, a.m., of the 20th October, 
when he was suddenly seized with vomiting and purging. 
When seen for the first time at 10, a.m., we found him out 
of bed, standing almost naked on the floor ; he said he had 
risen on account of the violence of the cramps. The surface 
of the body was quite cold, the tongue cold, the pulse could 
not be felt, the toes were quite turned in by the cramps, 
and he complained much of the violent pain in his legs. He 
was vomiting and purging a watery fluid. 

"He died at a quarter before 10, p.m., seventeen hours 
after seizure, and twelve hours after first visit." 

" R. A., aged 22, a man of sober, industrious habits, living 
in a comfortable room, without feeling unwell, took a dose of 
salts and senna as a precautionary measure, on the morning 
of the 22d of October, which operated in the course of the 
day. At 4, p.m., he was seized with vomiting, purging, and 
cramps. When seen at half-past 7, p.m., the surface of the body 
was cold and dark blue in colour ; the pulse was felt like 
the finest thread ; the jaw was hanging, and the eyes open, 
glassy, and turned up ; the tongue and breath were icy cold ; 
the voice a hollow whisper ; there was great thirst, watery 
vomiting and purging, and violent cramps in legs and arms. 

"He died half-past 1, a.m., of the following morning, nine 
hours and a half after seizure, and six hours after first visit/' 



112 ON EPIDEMIC CHOLERA. 

We could multiply examples of this kind to almost any 
amount ; but having shown what is meant by a sudden seizure, 
we shall give some instances of the occurrence of such among 
large bodies of men. 

" The first was in a body of five thousand troops at Gan- 
jam, 1781. 'It assailed them with almost inconceivable 
fury at that place, on the 22d March. Men in perfect health 
dropt down by dozens ; and even those less severely affected 
were generally dead, or past recovery, in less than an hour. 
Besides those who died, above five hundred were admitted 
into hospital that day. On the two following days the 
disease continued unabated, and more than one-half of the 
army was then ill/ "* 

Again, — 

"- Dr. Kennedy, in his treatise on cholera, relates that he 
was at Surat when a native corps left that station, in No- 
vember 1819. They were in high health, having had a few 
slight cases of cholera in October, but before the march they 
had all disappeared. He followed them a few days after on 
the route to Baroda, a distance of eighty miles ; and hearing 
nothing of cholera on the way, he was astonished on arriv- 
ing there to find the corps suffering from it in its worst form, 
their casualties being from eight to fifteen daily. ' The 
weather was cool and pleasant. There was really nothing 
to which, by ever so far-fetched a reasoning, we could ascribe 
the situation of these poor people. The rest of the canton- 
ment enjoyed perfect health, though breathing the same 
atmosphere, drinking water from the same wells, and procur- 
ing provisions from the same bazaar, whilst the most unre- 
strained intercourse existed between the infected battalion 
and the other two healthy battalions of the station. The 
city of Baroda and its suburbs were reported to be unaf- 
* Orton, op. cit., p 353. 



ITS PATHOLOGY— PREDISPOSING CAUSES. 113 

fected ; nor have I ever learned that the disease then existed 
in the adjacent villages ; and yet this solitary insulated body 
of hardy soldiery, in the vigour of manhood and exciting 
preparations for field-service, encamped upon a dry and open 
spot of as healthy ground as any in the neighbourhood, 
within the lines of a populous cantonment, and only a mile 
distant from one of the largest cities in India, seemed devoted 
alone to ' the pestilence that walked in darkness, and the 
destruction that wasted at noonday/ without any assignable 
cause, but that the seeds of the disease might have been 
sown in their constitution during the month of October, at 
Surat. Finally, the pestilence ceased as inexplicably as it 
had commenced, after having in less than three weeks nearly 
decimated the battalion." 

Our next quotation shall be from the work of Mr. Scot,* 
to which we have had occasion to refer frequently before. 
His work is the summary of the Madras Report, which ex- 
tends to 550 folio pages, besides his own opinion. It is the 
work of a man of undoubted talent, and of great experience. 

" This most formidable disease does not appear to be at- 
tended by any premonitory symptoms which can be regarded 
as being at all peculiar to it ; on the contrary, we may safely 
assert, that it is of sudden invasion ; for, though a slight 
nausea, a laxity of the bowels, and a general feeling of in- 
disposition are often found to precede cholera, yet these 
symptoms are evidently common to many other diseases ; 
and they are especially frequent in this climate, without 
being followed by any graver ailment. When such symptoms 
are found to precede cholera, they might with more truth 
be regarded as indicating merely a certain deranged state of 
the alimentary organs — a condition of the body which cer- 
tainly predisposes a person to an attack of cholera." 

Out of 236 cases treated at the Edinburgh Homoeopathic 

* Op. cit., pp. 42, 43. 
H 



114 ON EPIDEMIC CHOLERA. 

Dispensary, in 125 there had been gastro-intestinal derange- 
ment, and in 99 there had certainly been none ; the remain- 
der are entered as enfeebled by disease. If they be added to 
the number who had no gastro-intestinal derangement, then 
we should have 111 cases without this premonitory symptom, 
and 125 with it. Let it be observed, we have included all 
forms of gastric disorder. Had we confined it to diarrhoea, 
we should certainly have had less than-one half who had not 
this symptom, which has been called the first stage of cho- 
lera, and we should observe that, beyond all doubt, the most 
severe cases were those in which it was absent. 

We shall now consider the second question suggested by the 
Report under review, viz., Is diarrhoea a rare disease, and one 
which precedes no other malady but cholera ? Fortunately 
we have not far to go for a reply to this question ; for in the 
same Parliamentary Report,* occur the following words : — 

" From returns to inquiries which we addressed to the 
medical officers of the metropolitan Unions, with a view to 
ascertain the present state of disease in their several dis- 
tricts, and particularly among that portion of the population 
in which cholera chiefly prevailed at its last visitation, we 
learn that diarrhoea, in some localities, is, at the present 
time, co-extensive with typhus, and that in a few it even 
predominates. It must be borne in mind that the impure 
atmosphere which so powerfully predisposes to cholera, when 
that disease is epidemic, predisposes to diarrhoea, whether 
cholera be epidemic or not ; that diarrhoea is the constant 
precursor of typhus, as it was in 1832 of cholera;' that 
diarrhoea and typhus frequently pass into each other, and 
that diarrhoea, like typhus, is never absent from certain un- 
drained and filthy localities, where it divides the reign with 
typhus, and produces the like mortality." 

Again, in the same Report,-f* we have a reply to the part of 

* Page 26. fPp-27, 28. 



ITS PATHOLOGY — PREDISPOSING CAUSES. 115 

the question which refers to the frequency or rarity of the 
disorder : — 

" That some conception may be formed of the actual ex- 
tent of the prevalence of diarrhoea at the present time in 
certain localities of the metropolis, we cite the following 
statements, rather as an example than as a full account of 
the answers returned to our inquiries by the medical officers 
of the metropolitan Unions, these statements referring to 
the amount of disease among the pauper population only. 
From the Lambeth return it appears that there have oc- 
curred in this district within the last six months, chiefly in 
seven short courts and alleys, 638 cases of diarrhoea, together 
with 77 cases of typhus and 72 of scarlet fever. In one dis- 
trict in the parish of St. George the Martyr, Southwark, 
there are reported 113 cases of diarrhoea and 187 of typhus ; 
in another district 51 of diarrhoea and 91 of typhus ; and in 
a single street, 20 cases of diarrhoea, 11 of typhus, and 3 of 
scarlet fever. In Bermondsey, in 12 streets, with an aver- 
age of 18 houses in each, there were 120 cases of typhus ; 
and in another part of the same district, 50 of typhus to 18 
of diarrhoea. In Deptford there were 48 cases of diarrhoea, 
with 30 in addition, that passed into English cholera, to- 
gether with 186 of typhus and 88 of scarlet fever. In White- 
chapel Union, in 10 streets, of about 17 houses in each on an 
average, there were 642 cases of typhus to 126 of diarrhoea. 
In Christchurch, Shoreditch, there were 426 cases of diar- 
rhoea, many of which passed into typhus, the amount of 
typhus and scarlet fever together being 722. In Holywell, 
Long-alley, and its neighbourhood, there were, of diarrhoea, 
210, of typhus, 259, and of scarlet fever, 30 cases. 

" In the suburban and less crowded districts, it is stated, 
that in certain spots in Wandsworth, diarrhoea constantly' 
prevails, together with typhus ; and that in those places the 



1 1 6 ON EPIDEMIC CHOLERA. 

same persons have been repeatedly attacked in the course of 
the last six months. In the pleasant village of Hampstead, 
where such an amount of disease could hardly have been 
expected, there occurred 78 cases of diarrhoea and 58 of 
typhus ; and of these, 18 of diarrhoea and 34 of typhus took 
place in one street of only 26 houses. In the Hackney 
Union there were 269 cases of diarrhoea to 66 of typhus ; in 
West Hackney, 44 of diarrhoea to 3 of typhus ; and in Tot- 
tenham, 62 of diarrhoea to 12 of typhus/' 

We feel ourselves entitled to conclude, from the facts we 
have stated, that cholera in its most destructive form very 
frequently occurs without any previous diarrhoea, and that 
diarrhoea may prevail extensively without there being any 
cholera at hand ; and therefore diarrhoea cannot be con- 
sidered a first stage of the cholera, but must rank simply as 
one of the predisposing causes. 

We should gladly leave the matter here, for we feel it to 
be somewhat presumptuous to enter the field against the 
Sanitary Commission in reference to the advice they give for 
warding off so terrible a plague as cholera. But when we 
reflect that the lives of millions are likely to be more or less 
risked by recommendations issued from so high a quarter, 
and sure to be generally diffused by the periodic press 
through the country, we feel it would be wrong of us not to 
enter our protest in the most emphatic way against the 
method proposed to combat this so-called first stage of the 
epidemic. 

Under the head of the " Mode of treatment of the premo- 
nitory diarrhoea so as to arrest the disease entirely/'* we find 
the following law of cure laid down : — 

" With regard, therefore, to the means of prevention to 
be taken by individuals against an attack of cholera, should 

4 Op. cit., p. 22. 



ITS PATHOLOGY— PREDISPOSING CAUSES. 117 

this pestilence again return, the first and essential precau- 
tion is instantly to stop looseness of the bowels. The means 
of accomplishing this are simple, if the proper remedies are 
employed immediately the looseness comes on ; and the pro- 
per remedies are aromatic, opiate, and astringent medicines ; 
twenty grains of the opiate confection, for example, taken in 
peppermint water, weak brandy and water, or the common 
chalk mixture, and repeated every hour until the relaxation 
of the bowels ceases. By this simple remedy, if employed in 
this early stage, the evidence adduced justifies the expecta- 
tion that the progress may generally be arrested of a malady 
which, if allowed to advance unchecked to its second stage, is 
the most fatal and intractable disease known ; in the treat- 
ment of which the most opposite modes of practice — the most 
powerful and the most inert remedies — bleeding, brandy, 
opium, calomel, ammonia, quinine, croton oil, cold water, the 
warm bath, the cold affusion, all varieties and contrarieties 
of treatment possible, have been employed alike in vain." 

As we might expect, the popular instinct soon strips this 
passage of its euphuism, and for opiate confection, weak 
brandy and water, peppermint water, and chalk mixture, 
reads, opium and brandy — the simple remedy, which it is 
quite plain the Commissioners had in their eye. In Scot- 
land, however, where brandy is dear and whisky is cheap, 
they take the liberty of altering the recipe of the Commis- 
sion to suit the necessities of the case. 

If it were quite certain that opium and brandy really pre- 
vented cholera, we cannot but think that a wise legislature 
should have hesitated before recommending for popular use 
drugs, an indulgence in which is so ruinous to the health, 
and whose operation is of so fascinating a nature, that if 
once allowed to become a habit, it requires superhuman 
self-control to break the destructive thraldom. 



118 OK EPIDEMIC CHOLERA. 

Surely the bitter self-accusations of some of the most 
gifted men that have adorned and instructed our country, 
might have acted as a warning against sowing broadcast 
over the land so deadly, and yet so insidious a poison. "We 
repeat, if the alternative were put, as one was to David, 
whether we should prefer a brief and fatal epidemic of cho- 
lera, or the risk of a great increase of an endemic habit of 
intoxication by ardent spirits and opium, the former would 
be the kinder and wiser of the two to choose. 

We have put the case on the best footing for the Commis- 
sion ; but we must bring it down a long way, for we are 
satisfied that opium and brandy do not cure diarrhoea ; and 
if they did cure it, they would often leave the patient in a 
worse condition for what was to follow than if he had been 
Jet alone. 

We have had numerous examples of cases such as this. 
When the cholera prevails in a place, diarrhoea also prevails. 
A nervous person gets an attack of looseness of his bowels ; 
he sends for his doctor, who gives him a tea-spoonful of laud- 
anum to make sure against cholera ; the diarrhoea stops, but 
the bowels are bound, and some headach comes on ; again 
the doctor is sent for, and he gives a purgative, the headach 
goes off, and the looseness returns ; in a greater alarm than 
ever, his medical adviser is recalled ; again he gives a good 
large dose of opium in some form, with the same effect as 
before, only, that now giddiness and sleeplessness are super- 
added to constipation. What is to be done next ? Another 
purgative ? that will endanger the return of the diarrhoea — 
leave him alone ? that will bring on a state of constipation 
almost as dangerous as the diarrhoea. We do not know what 
better the patient can do than immediately leave the place, 
and get out of the hands of his most dangerous medical 
friends ; if not, he may have to go on taking opium and 



ITS PATHOLOGY— PREDISPOSING CAUSES. 119 

laxative medicines alternately for weeks together, till deli- 
rium tremens comes on, which, in our opinion at least, is a 
worse disease than cholera. We are not stating hypotheti- 
cal cases. We know such cases have occurred. This has 
happened especially to females approaching their confine- 
ment, and in some instances has rendered this simple and 
natural process one of extreme danger, distress, and anxiety ; 
we believe it has even produced fatal consequences. 

But suppose the diarrhoea, for which we have been so assi- 
duously giving our opiate confection and brandy, should hap- 
pen to be the precursor, not of cholera, but of scarlet or 
typhus fever, what would be the consequence ? Let any 
hospital physician be asked whether he would consider the 
risk from these diseases augmented or lessened by the pa- 
tient having previously taken large quantities of brandy and 
opium ? We are not putting an imaginary case, but what 
we ourselves have seen ; for example, when the cholera was 
at its height in Edinburgh on the 30th of November, we 
were sent for to see a little boy of eleven years old, who was 
reported to be ill of it. We saw him at four o'clock in the 
afternoon ; he had been quite well till ten o'clock that 
morning, when he was suddenly seized with watery purging 
and vomiting ; his pulse was 140, and weak ; he was giddy ; 
his tongue was natural, and of the usual temperature. Here 
was a case of incipient cholera surely, and proper for opium 
and brandy, which, however, we did not 'give. At nine, p.m , 
his pulse was lower, and he had vomited less. On the follow- 
ing evening he was covered with a red eruption, and the 
usual symptoms of scarlet fever appeared. He recovered. 
We may state the case thus for the popular understanding : 
Typhus fever, scarlet fever, and cholera, all begin occasion- 
ally with looseness of the bowels. This looseness is some- 
times cured by opium and brandy, but neither the typhus 



120 ON EPIDEMIC CHOLERA. 

nor scarlet fever is prevented by its being so cured, and the 
danger of these diseases is increased by the drugs ; if the 
looseness be the precursor of either typhus or scarlet fever, 
the person is certainly in a worse condition after his dose of 
opium than if he had been let alone, and it is very doubtful 
whether the cholera be kept away or not by stopping the 
diarrhoea in this manner. In these circumstances, is it right 
to give opium indiscriminately for diarrhoea when cholera, 
typhus fever, and scarlet fever, are all raging together in the 
same locality? 

We have yet other two objections to the opium and brandy ; 
the first is, that one great source of mortality in cholera 
treated by the old school, is the consecutive fever ; this is 
certainly not improved by the patient having previously taken 
stimulants and narcotics. 

Our last objection is on moral grounds. Cholera is a disease 
of the poor, and drunkenness is a vice of the poor. Let it be 
understood that opium and brandy are good for cholera, and 
the poor are too willing to believe that it cannot hurt them 
to take these drugs as a preventive measure. Let us record 
what we ourselves saw. In a flat in the old town of Edin- 
burgh a case of cholera occurred. The subject of it was a 
strong sober man ; he was ill only a few hours, and died. 
Two days afterwards we were sent for to see a woman lying 
in the adjoining apartment, also very ill of cholera. We 
found her in a state of collapse, and gave her some medi- 
cines, along with strict injunctions as to her management. 
This was about nine o'clock in the evening. We returned 
in about two hours. There were five women and a man in 
the room sitting round the table drinking spirits. We asked 
them if they had no fear of death ? and one of the women 
replied, that a doctor had been up, and told them there was 
nothing like brandy for keeping oif cholera. The poor 



ITS PATHOLOGY — EXCITING CAUSES. 121 

dying creature was almost breathing her last. She had 
been left lying as if she were already dead. She had got 
no medicine, and no attendance, and she died within an 
hour. We warned the party of the consequences of their 
revolting conduct, and that some of them would soon take 
cholera if they spent the night in drinking there, as they 
seemed inclined to do. This seemed rather to amuse than 
alarm them, so we went away, and observed to one of the 
women, who staggered to the door with a light in her hand, 
that if she went on as she had begun, she would not have 
long to live, and that perhaps she hardly felt prepared to die. 
She laughed. Next day she took cholera, and died ; another 
of the same party took it the following day, and also died. 

The cholera is a dreadful thing to witness. It is the most 
terrible form that death can present. Yet it is a positive 
relief to turn from the living in a state of brutal drunkenness 
— all pity and every human feeling drugged to death — to 
the poor dying creatures who suffer from the visitation of 
God and not from their own criminality. 

During the prevalence of cholera in Edinburgh, a very 
large number of patients labouring under diarrhoea applied 
to the Homoeopathic Dispensary, and we do not recollect a 
single instance in which the " simple" remedies given, which 
were chiefly Mercurius solubilis, Arsenicum, and Aciduin 
phosphoricum, were not sufficient to arrest the complaint. 

EXCITING CAUSES. 

The exciting cause of epidemic cholera may be stated to 
be a specific poison, or morbific influence of telluric origin, but 
capable of being reproduced, in some instances at least, by 
the organized beings which are affected by it, and the mani- 
festation of its baneful effects is accompanied generally by 
an unusual degree of humidity, either atmospheric or local ; 



122 ON EPIDEMIC CHOLERA. 

and we may add that a derangement in the weight, heat, 
and electric condition of the air have been frequently 
observed to attend an outbreak of the disease. Unwhole- 
some food may also perhaps be mentioned among its exist- 
ing causes. 

That cholera is produced by a specific poison is gener- 
ally admitted by writers upon the subject As to the essen- 
tial nature of this specific miasm we are entirely ignorant ; 
and we do not think it would serve any useful purpose 
to enter into a discussion upon the various hypotheses which 
have been proposed. For the most part the explanation 
offered to account for the mode of action of any one miasm 
will not cover the whole question ; and this, in our opinion, 
is a fatal objection, for it is obvious that they present but 
one problem ;. and the true solution, when it comes, will 
explain all the varieties of the phenomenon. 

The telluric origin of this poison seems clearly indicated by 
the sudden way it breaks out in various places at the same 
time, and its continuance in some situations ; resembling in 
this particular the malaria from the Pontine marshes, the 
eampagna of Rome, or from the unwholesome ground in the 
neighbourhood of some volcanoes, as for instance the country 
about Psestum. 

The connexion of the morbid emanation with the earth 
is further proved by the curious fact that there is no in- 
stance on record of a ship from Europe having a single case of 
this disease* on board until it has had communication with 
the shore.* 

As to its being reproduced by those affected by it — this 

is equivalent to its propagation by contagion, at least the 

latter proposition almost necessarily involves the former. 

The following extract from the British and Foreign Medico- 

* Scot, op. eit., p. 82. 



ITS PATHOLOGY— EXCITING CAUSES. 123 

Chirurgical Review for January 1849, expresses and illus- 
trates the general opinion upon this point : — 

" About 250 miles north-west of Madras, a range of lofty 
hills, called the Copper Mountains, forms the western boun- 
dary of an immense plain. A spectator standing at the 
base of the hills, and looking to the north and east, gazes 
over a vast expanse of country, which, nearly as far as the 
eye can reach, forms an almost uninterrupted and level sur- 
face. About six or eight miles away from him, however, a 
rounded mass of rock towers up abruptly from the plain, and 
breaks at this point the uniformity of the view. This is not 
one of those limestone rocks common in some parts of India, 
which are formed by the evaporation of water deeply charged 
with calcareous salts. This rock is granite ; about half a 
mile in diameter, and some 500 feet high. On its bare sur- 
face only a scanty vegetation grows, and the soil at its base 
is equally sterile and dried up beneath the fiery rays of the 
Indian sun. Such is the rock of Bellary ; and till within 
the last three or four years, the European barracks were 
situated in the Lower Fort, built on one of the inferior por- 
tions of the rock. There are no marshes, no rivers, no dense 
and exuberant vegetation which may afford to cholera a 
congenial soil ; and yet since 1818 cholera has never for a 
single year been absent from Bellary, and the place of burial 
of each successive regiment bears sad testimony to its per- 
manent and unrelaxed activity. And it is evident that it 
is something connected with the rock itself, which has to 
do with this development of cholera. The disease hangs 
about the Lower Fort, and rarely travels any distance from 
it ; it prevails severely in the barracks on the rock, in the 
native town and bazaars immediately adjoining, but it has 
almost uniformly spared the native lines and the adjacent 
buildings which are situated some three miles away. It 



124 ON EPIDEMIC CHOLEKA. 

is one of those striking examples of localization to which we 
formerly referred. The causes of this prevalence are to be 
found in the fact, that never were men placed under worse 
hygienic conditions than those living or quartered in the 
Fort. For military reasons, the space given to the buildings 
of both Europeans and natives is exceedingly limited ; the 
houses are densely crowded, and a numerous population is, 
or used to be, compressed into a space inconceivably small. 
Close to the European barracks are two dirty bazaars, which 
have long been considered as public nuisances. A large 
tank, which in the hot season becomes nearly dried up, 
furnishes its supply of effluvia ; and a very inefficient super- 
vision of the barracks themselves till latelv allowed the 

«/ 

emanations of a large body of men to furnish assisting con- 
ditions in aid of the poison/' 

The humid state of the air which precedes or attends the 
outbreak of the epidemic, has been noticed by many writers. 
Dr. Orton, observes, — " I have been personally informed 
by an intelligent officer who witnessed the different at- 
tacks of the epidemic in Brigadier -General Smith's force, 
at Seroor and other places, that they were always accom- 
panied by a cloudy, overcast state of the sky, sudden showers 
composed of large drops of rain, resembling those of a thun- 
derstorm, and a thick l heavy' state of the air, giving it a 
whitish appearance ; and whenever the weather cleared up 
the disease disappeared. He particularly observed, that the 
epidemic was invariably preceded and accompanied by a 
large black cloud hanging over the place ; and added, that 
this had been universally remarked, and that the appearance 
had even received the name of the cholera cloud. All these 
remarks were made without any questions or suggestions 
from me which could influence their tendency."* 

*Op. cit., p. 17<i. 



ITS PATHOLOGY — EXCITING CAUSES. 125 

Dr. Adair Crawford confirms the statement : — 

" Many observations prove that a damp state of the at- 
mosphere is one of the circumstances the most favourable to 
the development of the disease. This is the general condi- 
tion of the air along rivers and lakes, where the banks are 
often marshy, and covered with mist. In 1831, when the 
cholera broke out in the Polish army, while contending with 
the Russians on the banks of the Vistula, it was observed, 
(as reported to me by Dr. Dalmas, who had been sent to 
Poland by the French Government to study the disease,) 
that whenever the Polish army occupied low and marshy 
positions along the river, there was immediately a rapid in- 
crease of the cholera among the troops, and that each time 
they removed to higher ground the disease immediately de- 
creased/' 

It were easy to give more instances of a similiar kind, but 
it would serve no purpose ; it is enough to say that a humid 
state of the atmosphere has frequently been observed to at- 
tend the epidemic cholera, but that it is not essential to the 
production of the disease. The evil effects of a humid loca- 
lity in increasing the risk of cholera have been established 
by the history of the epidemic in its whole course. To be- 
gin with India, — 

" Seringapatam is one of those noxious spots so devoted 
to fever, that they should be shunned by man as a residence 
if he is unable to remove the cause. It lies in a basin, 
formed on all sides by hills, and is surrounded to a consider- 
able distance by rice-fields, watered from canals drawn from 
the Cauvery, and carried off at considerable angles from the 
river along the sides of the neighbouring heights. The 
ground between them and the parent stream is formed into 
a succession of terraces, and thus kept continually overflowed 
whilst the grain is growing, but suffered to dry up for its 



126 ON EPIDEMIC CHOLERA. 

ripening. To the miasmata thus produced I have always 
attributed the fevers which prevail there ; for there is neither 
swamp of any other description nor wood for a great dis- 
tance, and the natural soil is a dry, reddish, sandy substance, 
consisting almost entirely of decomposed granite. Here, as in 
all other similarly unhealthy places, the epidemic (cholera) 
prevailed to an extraordinary degree. Mr. Scott states, that 
it appeared, from the best information he possessed on the sub- 
ject, that the mortality was greater there than at any other 
place in the Peninsula. Very different was the case at Ban- 
galore, lying on an eminence seventy-five miles to the west- 
ward, 700 feet higher than Seringapatam, and 3000 above 
the sea : it is the highest ground of the Mysore, and the 
coolest and healthiest station on the establishment. It was 
never visited by the epidemic but in a very trifling manner. 

" After adverting to the attraction of the choleraic poison 
for moisture, and the remarkable predilection of cholera for 
all places where human beings are thickly crowded together, 
and where the effluvia from the excretions are consequently 
abundant, Dr. Parkes, late an army surgeon in India, de- 
scribes the rise and progress of two epidemics which he wit- 
nessed ; one in 1842, at Moulmein, in the Tenasserim pro- 
vinces, and the other at Madras, in 1845, both being, he 
says, fair types of the general manner in which cholera 
spreads in India. 

" ' Some time in the early part of 1842/ he says, ' cholera 
appeared in the northern parts of Burmah, and, passing in a 
southerly direction, committed great ravages, and caused great 
consternation at Ava and Ameerapoora. After traversing 
these cities, it passed down to Rangoon, pursuing the course 
of the Irrawaddy and its tributaries, and attacking chiefly 
the towns and villages situated on the banks of these rivers. 
Still pursuing a southerly course, in August it appeared in 



ITS PATHOLOGY — EXCITING CAUSES. 127 

the Burmese town of Martaban, situated on the junction of 
three great rivers — the Sal ween, the Attaran, and the Gryne, 
and nearly opposite to the British settlement of Moulmein. 

" ' In September, it appeared in Moulmein, and continued 
to prevail with greater or less violence till July 1843, when 
it disappeared, although an isolated case was occasionally 
seen during the two following years. Soon after its entrance 
into Moulmein, it was reported to have appeared in the vil- 
lages to the south, on the banks of the Salween, and on the 
sea side, and then still travelling due south, it reached in 
November the second principal Burman town, Tavoy. Tavoy 
is a place of considerable size, and is situated about ] 50 miles 
south of Moulmein, on the banks of a broad shallow r stream, 
loaded with debris from the neighbouring mountains. Cho- 
lera raged here with great fury for three or four months, and 
then gradually disappeared. Soon after entering Tavoy, it 
was heard of in the villages round the city. Travelling 
south, it showed itself shortly afterwards (some time in Ja- 
nuary 1843) in Mergui, the third principal town in the pro- 
vinces, situated on a small island, formed by two branches 
of the Tenassarim river, opening into the Bay of Bengal, 1 50 
miles to the south of Tavoy. 

" c During this progress from the north towards the south, 
cholera attacked chiefly, or exclusively, the towns and vil- 
lages stationed in low marshy places, on the banks of rivers, 
or on the shores of the sea. It did not extend inland, and 
the Burmans were accustomed to escape it by leaving their 
houses and travelling into the jungle. Directly the first 
death occurred in any village, the men deserted their fish- 
ing or their paddy fields, and betaking themselves to their 
endless forests, preferred the chances of famine and the 
dangers of the jungle to the risks of exposure to the attacks 
of cholera. They universally stated, that though they were 



128 ON EPIDEMIC CHOLERA. 

left without food by this flight, and were exposed to the 
burning noon-day rays, and to the heavy tropical dews at 
night, cholera universally left them after the third or second 
day's march inland. 

" e For many months the disease at Moulmein was confined 
almost entirely to the houses situated on or over the river, 
and chiefly to the south end of the town ; one side of the 
main street runs close to the river, and the great majority 
of cases occurred on this side ; comparatively few on the 
other. 

" ' The only Europeans attacked at the commencement of 
the epidemic, were the sailors belonging to the ships in the 
river. The ships nearest the shore suffered most. Thus nine 
cases occurred on board Her Majesty's brig Britemorte, lying 
close in shore ; she was moored about a mile away into the 
centre of the stream, and no more cases occurred. Three 
cases occurred on board Her Majesty's brig Syren, also lying 
in shore ; she was also moored into the centre of the river, 
and cholera immediately ceased. The 63d regiment sailed 
in September and October 1842, for Madras. One transport 
brig, accidentally detained three days in the river, had four- 
teen cases of cholera during the voyage ; the other trans- 
ports, four in number, got to sea at once, and had no cholera. 
A few cases occurred during this time among the Europeans 
on shore, but these consisted only of those who lived close 
to the river.' " 

It does not confine itself to swampy ground, but seems to 
affect rivers as well as pools. 

" Mr. Jameson says, ' From the rise of the disorder on the 
banks of the Ganges and Burrampooter, to its arrival at the 
mouths of the Nerbudda and Taptee, this has excited the 
surprise of the medical observer. Thus from Sunergong in 
the Dacca district, where the epidemic broke out in July 



ITS PATHOLOGY— EXCITING CAUSES. 129 

1817, it crept along the banks of the Megna to Narrian- 
gunge and Dacca, attaching itself chiefly to the ferries and 
market-places in its vicinity. In like manner, it afterwards 
advanced step by step up the Burrampooter, affecting, dur- 
ing its transit, the villages situated on both its margins. 
From the mouth of the Hoogly, to its termination in the 
Ganges, near Moorshedabad, the same peculiarity was ob- 
servable. The shipping at the new anchorage at Diamond 
Harbour, and along the whole channel, as high as the Hoogly, 
was particularly affected, and almost every village adjacent 
to its banks buried many of its inhabitants. In the Bhau- 
gulpore district, the propensity was so strong, that the virus 
scarcely ever spread into the interior, whilst it almost de- 
populated the low lands near the Ganges. Again, in the 
autumn of 1817, Moozufferpore, and the villages along the 
Gunduk river in Tirhoot, and the station of Chupra on a 
branch of the Ganges in Sarun, were alone visited, while at 
a subsequent period the disease was thence communicated 
along the Gogra to numerous cities in the north-east quarter 
of our territories. From Allahabad upwards, along the 
channel of the twin branches there forming a junction, until 
the river was lost under the hills, it wavered so little from 
the line of those rivers, that hardly a town or village lying 
remote from their course was brought within its influence. 
Without going further over our old ground, let us briefly 
state, that the same rule held yet more unexceptionably in 
Rajpootana, through the province of Bundelcund, and all 
along the Nerbudda to the numerous branches of the Chum- 
buL' "• 

We believe that the immense difference in the severity of 
the cholera in Edinburgh and Glasgow finds its explanation 
in the local rather than any other sanitary condition of the 

* Orton, op. cit., pp. 410, 411. 

I 



ISO ON EPIDEMIC CHOLERA. 

two cities. In reference to this interesting point, we may 
quote a few sentences from a recent article in the British 
Journal of Homoeopathy : — 

" The only general observation upon this head we are 
inclined to make, refers to the topography of Edinburgh as 
compared with that of Glasgow. By universal admission, 
the cholera has an affinity to water. While by some mysteri- 
ous law of progression, it has moved by steady steps in all 
kinds of weather, from extreme cold to great heat, against 
high winds, over every variety of country, from an easterly 
to a westerly direction, until it has now almost encircled the 
globe, it has preferred the courses of rivers for its local 
direction. In Scotland, it has moved up the Firth, the Clyde, 
and the Tweed. The topography of Edinburgh is very pecu- 
liar. It may be described as composed of two deep narrow 
valleys, one little better than a large ditch, and surrounding 
heights. In the valleys, particularly in the narrowest and 
deepest, are built old houses, very close together, and occu- 
pied by the poorest of the people, and the most dissipated : 
it is called the Cowgate. The other valley is but partially 
covered with houses ; it runs between the ridge of the old 
town and the new. These narrow valleys are bridged over. 
The higher grounds are covered for the most part with newly 
built houses. In the new town, which lies at the north side 
of the second or wider valley, the houses are spacious and 
scattered over a large space of ground. There is little or no 
direct communication between the inhabitants of the new 
town and those of the worse parts of the old. There is a 
moral as well as a physical gulf between them. The rich 
pass over, not through the town of the poor. Hardly a case 
of cholera appeared in the new town, its ravages were con- 
fined to the old town, especially the narrow valleys and the 
houses covering their steep sloping sides. 



ITS PATHOLOGY — EXCITING CAUSES. 131 

" Glasgow presents a total contrast. The city is built in 
the bosom of a plain on both sides of the Clyde. There are 
eminences covered with houses, where the best (so called) 
part of the community reside, but there is no abrupt tran- 
sition between their habitations and those of the poorest. 
It is a level surface, going off at parts in inclined planes. 
Here the cholera confined itself to no particular localities, it 
spread generally over the whole town, affecting all ranks. 
We believe the difference between the intensity and diffusion 
of the disease in the two places to be sufficiently accounted 
for by their relative topographies/' 

In speaking of the predisposing causes of cholera, we de- 
scribed the mode of cure of some of them ; and here, too, the 
question naturally suggests itself, can nothing be done by 
draining, or other such means, to prevent the occurrence of 
cholera? To enable us to reply to this satisfactorily, we 
have purposely divided the observations upon humidity into 
three classes : the first, the humid atmosphere ; the next, 
the damp locality ; and the third, running streams. We 
cannot prevent a humid atmosphere, neither can we dry up 
rivers, nor would we if we could, but we can drain moist un- 
wholesome soils about towns ; and if these towns be not 
situated upon rivers, they may remain altogether exempt 
from the cholera. We know no better illustration of the evil 
effects of a bad sanitary state of a town in giving rise to 
cholera, or at least tending to its development, than what 
was observed at Paisley. 

It may be incredible, but it is not the less true, that a 
considerable part of that tow r n, which has always been dis- 
tinguished for the industry and intelligence of its inhabi- 
tants, many of whom have become celebrated over all the 
civilized world, situated, too, in a well-watered country, " in 
the land of the mountain and the flood/' should be so wholly 



132 ON EPIDEMIC CHOLERA. 

destitute of water, that the only way it can be got is by 
stealing it during the night The report says : — 

" It (i.e., fever) is found generally in tenements kept 
in a filthy and abominable condition, and chiefly in lands 
where the town's water is not used. The occupiers of these 
lands are the poorest of the poor, the lowest of the low, the 
dissipated and the diseased — all grovelling in nuisances of 
the worst description. No water for domestic purposes, ex- 
cept what is stolen during the night in a small pitches — no 
water for personal cleanliness — and no water to wash away 
the numerous nuisances accumulating around their dwell- 
ings/' * 

We repeat, that it is hardly credible that such a state of 
things should exist in a country boasting of its civilisation ; 
and it is no wonder that persons so neglected should be the 
prey of typhus fever and cholera — both diseases attended 
with intense thirst — and no water to be had but what was 
stolen at night in a small pitcher ! 

" According to the experience of the above tables, they 
show that out of every hundred cases of cholera that have 
occurred in the Town proper, 35 have happened where the 
town's water is used, 17 have died, and 18 recovered; and 
65 cases have occurred in properties where the town's water 
is not used, 41 have died, and 23 recovered. It must, how- 
ever, be kept in view, that the landlords of a number of the 
worst properties in town pay for the water to their tenants, 
to prevent disease. One of these tenements contains a 
population equal to the adjoining parish of Inchinnan ; and 
the poor inhabitants of that property are also equal in an- 
other respect to their rich neighbours of Inchinnan, by not 
paying any poor-rates. 

" In making another calculation, inclusive of Charleston 

* Paisley Fever and Cholera Report for 1848-49, p. 1. 



ITS PATHOLOGY — EXCITING CAUSES. 133 

cases, it shows that out of every hundred cases of cholera 
occurring, 12 will happen in properties using the town's 
water, 6 of whom will die, and 6 recover ; and 88 will hap- 
pen in properties not using that water, 44 of whom will die, 
and 44 recover/'* 

We may mention an incident that came under our notice 
in Edinburgh in connexion with the want of water. A con- 
siderable time after the cholera had been in the city, the 
authorities began to take measures for cleansing the worst 
part of it. To do this they drew water from the city wells, 
which supply the poor with water. To prevent the supply 
to the engines used to wash the houses from running short, 
they locked up the wells at night. The consequence was, 
that many families who had not time, or had neglected to 
get water in the day-time, had none all night. The cholera 
generally occurs at night. A poor man was ill of it, and 
during the night his daughter, who had been attending him, 
was seized with the disease ; all the water was done, and in a 
state of intense agony from thirst, she rushed out to get some 
from a neighbour, and struck herself on the door. She fell 
to the ground, from which she could not rise, but was lifted 
to her bed, where she soon died. This is a digression ; but 
it is to show the horrible inhumanity of depriving the poor 
of water at a time when they are exposed to cholera. 

We may conclude, then, that while we cannot avert the 
plague from such towns as Edinburgh and Glasgow — the 
former exposed to a damp atmosphere, the latter situated 
on a river — we may prevent it altogether, or at least greatly 
mitigate its severity, by judicious sanitary measures in such 
towns as Paisley. 

The impression upon the mind of almost all observers of 
cholera seems to be, that at the time of its prevalence, there 

* Paisley Fever and Cholera Report for 1848-49, p. 2. 



134 ON EPIDEMIC CHOLERA. 

was something unusual about the weather ; it was unnatu- 
rally hot, cold, wet, or stormy. Dr. Orton, who strongly ad- 
vocates this opinion, has collected a number of testimonies 
in favour of this belief. "We may quote some of the most 
striking : — 

" The epidemic appeared and prevailed in its greatest vio- 
lence at Bombay in the latter part of August. Mr. Jukes, 
who was stationed at Tannah, on the island of Salsette, and 
about twenty miles from the town of Bombay, in a letter to 
the Medical Board, observes : — ' In order to afford you every 
information in my power, I will just add, that to common ob- 
servation there has been nothing very particular in the state 
of the weather. The barometer has neither been particularly 
high nor low. The thermometer, for the last month, has 
scarcely ranged more than from 75° to 82°, and many days 
nearly stationary at 78° or 79°. Leslie's hygrometer, accord- 
ing to the days, has ranged from 8° to 20°. The fall of rain 
in August was unusually great ; measured by Howard's plu- 
viometer, we had upwards of forty-eight inches/ Some 
idea may be formed of this enormous quantity of rain, when 
it is recollected, that even in the rainy climate of Great 
Britain, not more than thirty-two inches, on the average, 
fall annually. The Bombay Gazette of September 30, like- 
wise mentions, that thunderstorms of unusual violence had 
occurred there of late. Accounts from Surat and Broach 
also lament the damage done there by the c unusual fall of 
rain ' in August/' 

" It appeared at Bellary about the middle of September. 
The weather during its prevalence was extremely unsettled, 
usually cloudy, squally, damp, and rainy, but occasionally 
clearing up suddenly, and as suddenly presenting again the 
former appearances. 

" The disorder appeared for the first time in H. M. 34th 



ITS PATHOLOGY — EXCITING CAUSES. 135 

regiment (excepting one case) on the 21st of September, and 
committed dreadful ravages before night. It is therefore evi- 
dently of the highest importance to ascertain the state of the 
atmosphere on that memorable day. Mr. Allardyce, the sur- 
geon of the regiment, reports to the Medical Board : — ' Dur- 
ing the whole of the day of the 21st, the weather was un- 
usually close and excessively oppressive, with a clear sun. 
At 10, p.m., we had a violent thunderstorm, with two hours 
incessant and heavy rain. It rained again heavily the whole 
night of the 22d. The 23d was hot and close, but no rain 
fell at our camp on that day, though a considerable quantity 
fell all around us. It rained again on the morning of the 24th, 
and very heavily the whole of that night/ On the 25th the 
disease abated remarkably, and in three days more entirely 
disappeared. I am not particularly informed of the state of 
the weather after the 24th, but it is generally mentioned 
that ' it became fine when the disease disappeared/ " 

Again — 

" Mr. Mackenzie, surgeon to the Governor's Body Guard, 
observes, in a report to the Board, (13th of October) : — ' It is 
a question (notwithstanding the protracted prevalence of the 
epidemic in various parts of India) as yet undetermined, what 
its predisposing causes are. Various opinions have been 
given, but all of them admit of unanswerable objections. 
That, however, some peculiar state of the atmosphere has 
influence, as an exciting cause, is generally admitted. In 
this part of the country one circumstance has struck all 
classes of people — the very great change in the state of the 
weather which has marked the present year. From June to 
October, thirty inches of rain are stated from good authority 
to have fallen, when during the same period in former years 
from three to five inches have been the average quantity. 
Added to this material change in the seasons, the atmos- 



136 ON EPIDEMIC CHOLERA. 

phere has, during the same time, been charged in a greater 
or less degree with electric fluid, and thunderstorms have 
succeeded each other almost in nightly succession. The 
thermometer has shown, during the year, a greater altera- 
tion in heat and cold than has been known for a long time/ 

" On the 24th of October, when the epidemic was at its 
height at Madras, a hurricane, unprecedented in violence for 
many years back, occurred there, which did great damage to 
the shipping in the Bay, and was felt, within a few hours of 
the same time, in many other parts of the Peninsula. After 
this event the weather at Madras cleared up, and the epi- 
demic abated. f ' The weather since the storm has been un- 
commonly fine for the season — latterly resembling that after 
the monsoon. This is a most gratifying circumstance, both 
on account of the shipping, as well as its having afforded an 
opportunity for repairing much of the damage done on shore. 
Hopes were entertained that the change in the atmosphere 
produced by this visitation would have favourable effects with 
regard to the epidemic ; these hopes appeared to have been 
realized, as we are happy to find, that in parts of Madras 
where there were numerous cases ten days ago, there are 
scarcely any; and that this favourable change has taken 
place in consequence of the alteration in the atmosphere pro- 
duced by the storm, is no unfair conclusion/ " 

After many other examples of a similar kind, Dr. Orton 
adds : — 

" If to this mass of positive evidence be added the nega- 
tive proof, that in all my experience, and in all the re- 
searches which I have made into this part of the subject, I 
have not met with a single instance in which the disease is 
found or stated to have appeared in the serene and settled 
weather which usually occupies so large a portion of the year 
in India, to such an extent as to be termed epidemical, surely 



ITS PATHOLOGY — EXCITING CAUSES. 137 

its connexion with the opposite state of the atmosphere can- 
not longer remain in the smallest degree doubtful/' 

We have said that the impression on the minds of almost 
all observers was, that there was something unusual in the 
weather. "We do not know whether or not this impression 
has been corroborated by scientific observations. There is 
considerable ambiguity in the following passage, which we 
quote from Mr. Scot's recent Report, and as the tables he 
refers to are not published, we are at a loss to understand 
what his meaning is, and whether the conclusion he seems 
to arrive at be warranted by the facts or not ; for it must be 
a most laborious and wearisome task to go through a series of 
meteorological tables extending over a period of six years, 
and derived, we presume, from many different parts of India. 
In quoting the passage, we shall omit the tables which give 
the per centage of natives and Europeans who were sick in 
different years, and satisfy ourselves with giving his general 
results. 

" In order to afford the most ample information respecting 
the phenomena of the weather, and their effects on the 
health of the troops, a series of meteorological tables, and 
of tables of diseases, from the year 1815 to 1821, are given 
in the Appendix. A certain intemperature of the atmos- 
phere may perhaps be inferred from the results of the tables 
of diseases ; but its nature will not, it is apprehended, be 
very readily discoverable in the sensible changes of the 
weather. 

" The general health of the European troops would appear 
to be restored, in 1822 and 1823, nearly to what it was in 
1815 and 1816. The increase of sickness in 1817 is about 
15 per centum ; but in 1818 to 1821, the increase, inde- 
pendently of cholera, is very considerable, and is not to be 
explained by the movements of troops during these years. 



138 ON EPIDEMIC CHOLERA. 

The general health of the native troops appears to have 
been considerably meliorated in the last two years ; while 
a remarkable increase of sickness, independently of cholera, 
has prevailed among them, coincident with that in the 
European troops. By a reference to the meteorological 
tables, it will be seen that the mean altitudes of the baro- 
meter and thermometer never differ, in a degree at all im- 
portant, one year with another, from 1815 to 1821. Accord- 
ing to the note at the end of the tables for the year 1820, 
the barometrical mean of the five years, from 1815 to 1820, 
corresponds exactly with the mean of the five preceding 
years ; and that the thermometrical mean for the same 
period only differs by a degree and a quarter. The principal 
variations distinguishing the years 1817 and 1818 are to be 
found in the quantity of rain and the direction of the winds. 
How far we are to connect cholera with these phenomena 
must be judged of with careful reference to the mode of its 
progress through the Peninsula. In 1817, the disease did 
not appear ; in 1818, it appeared in the most northern parts. 
In some places the weather was then wet, in others dry ; in 
some, the usual periodical rains were prevailing. It pro- 
gressed in all situations ; and it had not extended to the 
southernmost points till 1819, when the irregularities of the 
preceding seasons might be concluded to have lost their 
effects. After the seasons have been restored to their wonted 
regularity, and, more lately, (1823-24,) after a completely 
opposite state to that of 1818 has prevailed — to wit, a season 
of unwonted drought, owing to the failure of the rains of the 
NE. monsoon, cholera has still unhappily continued to pre- 
vail ; sporadically, in all parts, and in the instances of many 
marching corps epidemically, and with much severity and 
mortality. If the irregularity of the seasons in 1817 and 
1818, therefore, have given rise to cholera, we apprehend 



ITS PATHOLOGY — EXCITING CAUSES. 139 

it can only be in an indirect, and, to us, an unknown man- 
ner ; and its continuance, after having once originated epi- 
demically, appears to be unconnected, in the main, with any 
sensible state of the weather/' 

We may make the same observation in regard to the electri- 
cal state of the atmosphere as to its other conditions ; there 
is a general impression in the minds of most persons who 
have had much opportunity of observing the cholera, that a 
very considerable disturbance of atmospheric electricity, al- 
most constantly, has been a frequent concurrent phenomenon. 
We have already referred to various writers who mention 
this as their opinion, in very different situations, as for ex- 
ample Petersburgh and Sunderland, and we shall quote one 
curious passage from Dr. Orton's work which we have already 
so largely laid under contribution. Before doing so we may 
observe that Dr. Orton tries to establish the position that 
the cholera is caused by a deficiency of electricity, and he has 
adduced many instances of all the various phenomena at- 
tendant upon such a condition, and shown, or tried to show, 
that the same phenomena are met with when cholera 
breaks out. His chapter is extremely interesting, and we 
only regret that want of space prevents our doing fuller 
justice to his ingenious investigations. We trust that if the 
cholera appear in this country, the most accurate meteoro- 
logical observations may be kept in every place where it 
occurs. The following quotation is given rather with a view 
to interest our readers on the subject than to prove any par- 
ticular point. 

" Dr. Heyne, in his ' Tracts on India/ observes, — ' These 
commotions of the earth are never very violent, and by no 
means frequent in this country, occurring about once in five 
years. I felt one at Toomkoor (in Mysore) on the 23d Octo- 
ber 1800. It is remarkable that at the same time a violent 



140 ON EPIDEMIC CHOLERA. 

hurricane raged along the coast from Ongole to Masulipatam. 
The shock seemed to come from the north, along the inland 
range of hills. During the violent hurricane at Ongole, just 
mentioned, large masses of fire were seen to fall upon these 
hills, so well known for their influence on the needle, and rain 
fell at both places during the time in the greatest abundance. 
These hills are chiefly composed of a kind of magnetic iron- 
stone/ The coincidence between these observations and the 
following by the editor of the Madras Courier, is very re- 
markable : — 6 An earthquake, a phenomenon very unusual, 
we might, we believe, say almost unprecedented in this part 
of India, occurred on the 16th inst. (June 1819) in various 
parts of the Peninsula/ After describing its effects at Com- 
baconum (in the southern part of the Peninsula), he says : 
' So little known is such a visitation, that the moonsif quotes 
his Hindoo Shasters as foretelling that an earthquake would 
some time happen.* We may here mention, as connected 
in a manner with the earthquake, that on the same date a 
tremendous thunderstorm happened at Masulipatam. The 
lightning was terrific, and in the height of the storm the 
electric fluid struck a bungalow in which were three gentle- 
men. It is described as " appearing like a ball of fire, which 
burst with the report of a fourteen-inch shell/' * * * The epi- 
demic still carries off numbers at the Presidency and its 
vicinity. It is stated to be raging with great violence on the 
Hoogly among the shipping. No less than three chief officers 
of ships in the river died of the disease in one day/ An- 
other such coincidence occurs in the Asiatic Journal for May 
1817: — 'Madras, Sept. 24, 1816. During the last week, the 
neighbourhood of Madras was visited by some severe storms, 
which, however, have not had the effect of clearing the sultry 

* «« The minarets of a mosque at Ahmedabad, which had stood four centuries, 
were completely thrown down by this earthquake." 



ITS PATHOLOGY — EXCITING CAUSES. 141 

atmosphere usually felt so oppressive at this season of the 
year. About four o'clock on Monday morning, a slight shock 
of an earthquake was felt at Madras. This phenomenon, so 
rare on this coast, was followed, on Tuesday night, by one of 
the most awful storms we ever witnessed/ 

" The person who gives an account of a shock at Mymen- 
sing on the 15th of November, 1819, states that c the weather 
for some time before had been cool and clear, but on the 
12th it became cloudy and overcast, and the atmosphere 
heavy and warm/ That of Wallajabad on the 2d of October, 
is stated to have happened on a stormy night with heavy 
rain, and a flash of lightning was observed at the instant 
of its occurrence. 

" The rainy season commences nearly all over India 
usually about June, and therefore the occurrence of the great 
earthquake of the 16th of that month (1819) corresponds to 
that period. The ' Oriental Star/ of the 19th of June, men- 
tions that ' heavy gales of wind had lately prevailed at the 
head of the Bay of Bengal \ and that of July the 3d, in- 
forms us, that shortly before, a severe storm and inundation 
had been experienced about Chittagong and Dacca. About 
this time also the epidemic was raging at many places with 
great severity. 

" Mr. Jameson, Secretary to the Medical Board of Bengal, 
has given a detailed account of the state of the weather at 
Calcutta, which appears to be connected with the earth- 
quakes that happened there and in other parts of Bengal, on 
the 11th of November, and several subsequent days. ' Two 
or three cold, sharp days (in October), with clear sky, and 
northerly wind, were succeeded by nearly a month of such 
damp, disagreeable weather, as to the experienced eye clearly 
foreboded the return of cholera. The air was then hazy, raw, 
cold, and uncomfortable to the feel. The thermometer 



142 ON EPIDEMIC CHOLERA. 

ranged from 74° to 83°, but it felt much colder. There were 
no sudden variations of temperature. The appearance of the 
sky was peculiar : it was cloudy, but only partially so. The 
clouds were not dense, or heavy, or fleeting ; but thin and 
fixed, with frequent breaks, through which the blue sky 
appeared. They were generally of a dark grey colour ; flat, 
dull, and gloomy ; and for several days formed a long, broad, 
fixed bank towards the west and north-west verge of the 
horizon, and remained wholly unchanged in shape or ap- 
pearance. The wind varied from north-west to north-east. 
There was seldom regular sunshine. This state of things 
continued till the 12th, when there was a severe shock of an 
earthquake, followed by rain and variable winds for several 
successive days till the 20th, when a dry cold wind came 
round from the west, and brought with it a clear sky and 
regular weather. During the whole of this period of irregu- 
larity, numerous cases of the disease occurred, and proved 
very fatal in Kallinga and other native departments of the 
town ; but no sooner had the season become regular, than 
the epidemic ceased to be heard of/' * 

The only other exciting cause which remains to be noticed 
is unwholesome food and drink, and we may add improper 
physic. When there has been a habitual use of those dele- 
terious articles, then a state of the system may be produced 
which is liable to an attack of cholera ; but the considera- 
tion of this belongs to the head of predisposing causes, and 
may be included in the general division of poverty and des- 
titution, for the poor have no choice in their food ; they 
are thankful to have food at all ; and the only kind of it they 
can procure is often very injurious to them when the cholera 
prevails. Superstition is as mischievous in some countries as 
destitution is in others ; for example in Petersburgh : — " The 
* Orton, op. cit., pp. 264-267. 



ITS PATHOLOGY — EXCITING CAUSES. 143 

month of June, when the disease appeared, is the period of 
one of their long religious fasts of three weeks' duration. 
The people abstain all this time from the use of animal food 
of every kind, including milk, eggs, and butter. The diet 
consists chiefly, besides fish and rye-bread, of vegetables, 
such as cabbage, cucumbers, and other varieties of the 
pumpkin tribe, dried mushrooms, salads, &c, which are often 
eaten raw, and dressed with linseed oil and vinegar ; their 
ordinary drink is an acid kind of beer, made of rye-meal 
and malt fermented, called quass : they are greatly addicted, 
also, to the use of ardent spirits. This diet, besides being 
very lowering for labouring people, is of a nature to create a 
tendency to bowel complaints. Although the Archbishop 
allowed the people to dispense with the fast, and the Em- 
peror ordered meat for the soldiers, such was the strong at- 
tachment of the lower classes to their accustomed rites, that 
they generally continued the observance of the fast, and it 
was sometimes found difficult to persuade them to take even 
a little broth, although the saving of their lives seemed to 
depend on their being sustained by suitable nourishment/'* 

The following quotation from Mr. Scot's work brings into 
view how improper aliment and physic excite the disease : — 

" Many instances are noticed where cholera has super- 
vened on the use of neutral purgative salts. The effect of 
these medicines bears, indeed, a strong resemblance to some 
of the appearances in cholera. The clear, watery, debilitat- 
ing stools; the chill, and, in feverish subjects, the ague 
fits which they cause, obviously point them out as unsafe, 
especially during the prevalence of this disease. Cases of 
cholera terminating in death have occurred after drinking 
unwholesome liquors. An instance of this happened in a 
party of six men, who, after drinking together, were all 

* Crawford's Observations on Asiatic Cholera, p. 7. 



144 ON EPIDEMIC CHOLERA. 

seized with it, in consequence of which several of them 
died. Three men, having eaten, at the same time, the seeds 
of the coral plant, had all the symptoms of severe cholera." 

So much for the predisposing and exciting causes of the 
disease. We have spoken only of the more prominent and 
unquestionable ; to have attempted more would have required 
greater space than is consistent with the design of this 
treatise. We now pass to a consideration of 

THE PROXIMATE CAUSE OF CHOLERA. 

Suppose a labouring man returns home of a dull, drizzly 
evening after his day's hard work, and instead of finding his 
supper ready for him, finds his room in an uproar, and his 
wife ill of cholera : suppose that after giving his assistance 
all night till she dies, he lies down without eating anything, 
exhausted and distressed, upon some straw 7 beside her bed, 
which is on the level with the floor, we should then have a 
combination of the predisposing and exciting causes of the 
disease : and suppose he suddenly manifested the character- 
istic symptoms of the disease, and we were asked to tell 
the nature and seat of the first change in his system which 
had so suddenly transformed a strong, healthy man into a 
shrivelled, convulsed, speechless patient, more like a corpse 
than a living being ; the answer to such a question would 
be an account of the proximate cause of the disease. It is 
obvious that the discovery of this proximate cause, this in- 
ternal change, is much more difficult than the determination 
of the external exciting causes or the predisposing ones ; 
and while there is a general consent in regard to the latter, 
there is a great diversity of opinion about the former. It is 
not our intention to notice all the conjectural causes which 
have been assumed and proposed to account for the symp- 
toms of cholera, we shall only advert to two opinions upon 



ITS PATHOLOGY — PROXIMATE CAUSE. 145 

the subject, which appear at present to have by far the 
largest number of adherents, and one of which seems to us 
by much the most plausible. 

The first opinion is thus stated by the Sanitary Commis- 
sion in their Report : — 

" Asiatic cholera appears to be caused by a poison diffused 
in the atmosphere, which acts with peculiar intensity on the 
mucous membrane of the alimentary canal. The irritation 
set up in this membrane, in most cases, is not violent at 
first ; but if it be allowed to continue unchecked many hours, 
it produces such an extraordinary change in the membrane, 
that the thinner and colourless portion of the blood is poured 
out from it with the same rapidity as it would be if a large 
opening were made in the great vein of the arm." 

Miiller mentions that in Berlin, amid the innumerable 
theories promulgated in that prolific capital, the one most in 
vogue when he was there, in September 1848, (it is probably 
obsolete long ago,) may be thus stated : — Cholera " consisted 
in a very acute catarrh of the intestines, combined and essen- 
tially associated with certain peculiar symptoms, which were 
an extremely rapid transudation of all the fluid parts of 
the blood ; and in consequence of this, a rapidly developed 
paralysis of the nerves."* Broussais says, it is the action of 
an unknown agent upon the alimentary canal, which pro- 
duces " exageration de Taction nervososanguine, et super- 
secretion muqueuse/'-f- Or in the language of Dr. Suther- 
land, that the cholera is a serious haemorrhage from the 
bowels. 

Our objections to this opinion in all its modifications are 
twofold ; the first is, that most unequivocal, and what we 
would call typal cases of cholera, run their course with little 

* Op. cit., p. 46. 

f Oours de Pathologie, par F. G. V. Broussais, T. V., p. 477. 
K 



146 ON EPIDEMIC CHOLERA. 

or no discharge from the bowels at all, and that there is no 
appearance of any of those symptoms we are in the habit of 
seeing attendant upon bleeding to death. As an example, 
let us mention a case which came under our own observation. 
A healthy young man had been at his work till four o'clock 
in the afternoon, when he returned home and went to bed 
beside his father, (a poor old Frenchman, a follower of 
Charles X. into Edinburgh.) We arrived at the house at 
nine in the evening, and his father told us that his poor boy 
had been perfectly well till that day, that he had been over 
the bed ten minutes before, and was violently cramped. On 
turning to the lad himself, we found him stiff and dead. 
He had died convulsed in the bed with his father, without 
his father knowing it, and had been able to get up and stand 
ten minutes before his death. There is a multitude of simi- 
lar cases on record, although we believe few so painful in 
every particular. Mr. Scot* says, the absence of purging 
appears to denote a peculiar degree of malignancy in the 
attack. In short, in the worst kind of cholera, that peculiar 
symptom of intestinal haemorrhage does not occur, therefore 
flooding from the bowels cannot constitute the proximate 
cause of the disease. 

Our other objection is, that cholera may be cured as 
rapidly as it makes its invasion, which is quite incompatible 
with its being dependent upon violent haemorrhage. We 
need give no farther illustration of this after the case of Dr. 
Quin, to which we have already adverted. 

We may then dismiss this cause as neither proved to exist, 
nor sufficient, if it did, to produce the phenomena for which 
it is called to account. 

The other opinion of the proximate cause of cholera is, 
that it is a morbid affection of the ganglionic system of 
* Op. cit., p. 48. 



ITS PATHOLOGY— PROXIMATE CAUSE. 147 

nerves, and more especially of the solar plexus. We cannot 
establish this theory by direct proof; all we can do is to 
show that some powerful morbid action taking place in this 
system of nerves might account for all the symptoms of the 
disease, and that, in the manner and rapidity of its effects 
upon the frame, it bears an analogy to those agents which 
seem to act also primarily upon the nervous system. 

Without entering upon controversial topics, we may state 
that the generally received opinion of the function of the 
ganglionic or sympathetic system of nerves is to endow the 
various organs over which they are diffused — and that is all 
the organs of the body — with their peculiar vitality, and to 
associate them together, so that an impression made on one 
organ may be conveyed to another at a distance. It is no 
matter for our present object whether this be done by the 
ganglionic nerves "per se" or in virtue of their intimate 
union with another set of nerves. In short, the ganglionic 
system is the seat of life, and through this seat of life there 
run all the chords of motion, sensation, and sympathy. An 
influence operating upon it has a double action ; it affects 
vitality directly, and it acts upon all the functions of the 
body, because all these functions are more or less controlled 
by the nervous system. 

Suppose a noxious power to act upon the ganglionic sys- 
tem, what should we expect to be the consequences? If 
the action were intense, it might arrest all vitality, and life 
might cease suddenly with a general convulsion of the frame. 
It would be like the cold finger of death touching the 
balance-wheel of the machine, and instantly arresting all 
the wheels whose complicated movements constitute the life 
of our wonderful organism ; or if the action were not suffi- 
cient for this, it would sensibly depress the vitality of the 
system as its primary consequence, and derange all its func- 



1 48 ON EPIDEMIC CHOLERA. 

tions as the secondary effects. This seems to be exactly 
what happens in cholera. When the poisonous agent is very 
potent and malignant, very speedy death takes place with 
few general symptoms. When the poison is weaker, then we 
have a great number, and a great variety of symptoms. We 
might say, that the only essential symptom of cholera was 
death ; that all the other symptoms were merely concomi- 
tant. The most important morbid impressions are propa- 
gated along the various nervous tracks which freely inoscu- 
late with the ganglionic system. The influence traverses 
the respiratory nerves which supply the heart and lungs, 
and the patient's first definite sensation of disease is con- 
nected with the heart. The exclamations, " Oh, my heart I" 
and " my heart is bursting \" and " something is wrong with 
my heart I" we have heard repeatedly from persons ill of 
cholera. This influence produces a sense of extreme depres- 
sion at tli£ heart, or an intolerable load there. It destroys 
the function of the lungs ; the breath comes from the chest 
as cold as it enters ; respiration goes on, but no effects are 
evident, and it is like the mechanical breathing of a corpse. 
The consequence of this is that the blood does not undergo 
the requisite changes. It is no longer purified and arterial- 
ized in the lungs, but continues dark and venous, and thus 
gives the livid colour so characteristic of the disease. Hav- 
ing acquired no heat in its transit through the lungs, it can 
give none to the rest of the body, which remains deadly cold. 
All secretion requires a certain nervous influence, and this 
being at an end, or perverted, the different organs cease to 
perform their functions. The matters which should be eli- 
minated from the blood remain in it, so that not only is 
there no purification at the lungs, but all the other impuri- 
ties of the body accumulate in this " pabulum vitce." In- 
stead of secretion we have discharges. The withdrawal of the 



ITS PATHOLOGY— PROXIMATE CAUSE. 149 

proper nervous influence from the mucous membrane of the 
bowels, and the state of the blood produce such a condition 
of that substance, that the thinner part of that fluid escapes 
in violent gushes both from the intestines and from the sto- 
mach. So much for the effects of this morbid influence upon 
some of the organs supplied by the ganglionic and respira- 
tory nerves. Not less striking are the results of its propa- 
gation along the motory nerves. Through them it produces 
the most violent cramps in the various voluntary muscles, so 
that an attack of cholera has been mistaken for tetanus, 
and has been compared to hydrophobia and other convulsive 
diseases. It has also a marked effect upon the organs of the 
senses. The eyes are dull, there is singing in the ears, the 
voice is strangely altered, becoming a hollow whisper. The 
intellect alone is unaffected. It is obvious, that after such 
a morbid impression has ceased to act, the system must take 
a long time to recover from the disorganization of its ele- 
ments. Instant cure may be possible at the very first before 
the secondary effects of the morbid action in the ganglionic 
system have commenced ; after that it is impossible. The 
poisonous blood cannot be removed, and pure blood put into 
the veins ; this must be a slow process, and so long as this 
goes on, great danger must attend the case. Cholera, unless 
instantly arrested, must therefore always be a most danger- 
ous disease under any system of treatment. 

We may now assume that the hypothesis of a primary 
morbid action in the ganglionic system would satisfactorily 
account for most of the symptoms of cholera, and we shall 
next consider the evidence in favour of such a condition be- 
ing actually present. Any direct evidence derived from the 
morbid anatomy of the disease comes properly into the next 
division of the subject, where it will find its place ; and in 
the meantime we shall direct our inquiries to ascertain 



150 ON EPIDEMIC CHOLERA. 

whether other morbific influences, which act primarily 
through the nervous system, afford any analogy in the 
effects they manifest with those which characterize cholera. 

As there is a strong tendency at present to revive in a new 
form the old humoral pathology, and to deny altogether the 
direct action both of morbific and remedial agents upon the 
nervous system, we must adduce some proofs of the counter- 
proposition. 

In the first place, we shall show that sudden impressions 
upon the ganglionic nerves may cause death without any- 
thing actually passing into the blood. Lobstein, in his trea- 
tise on the sympathetic nerves, makes the following obser- 
vations : — 

" There are many instances in which injuries inflicted 
externally upon the epigastrium have produced death 
by their mechanical effects. 1st The dropping of water 
from any height upon the scrobiculus cordis cannot be long 
borne. 2d A boy was killed from being struck by a play- 
mate on the epigastrium with a snow-ball, which left no 
visible marks on the organs within. Sd. Ruisch, who during 
fifty years taught anatomy at Amsterdam, states that sudden 
death may occur from a concussion of the mesenteric nerves 
(solar plexus) without the existence of any lesion in them 
which can be detected. Hh. An electrical discharge through 
the abdomen may cause instantaneous death. This is con- 
firmed by Humboldt, who saw himself the electrical eels, 
(Gymnotus Electricus,) when placed under the bellies of horses 
and mules, destroy the lives of these animals, by the sudden 
emission of their electric fluid. 5th. In the recession of the 
miliary exanthemata, by which patients are suddenly de- 
stroyed with a development of the severest symptoms, inex- 
pressible anxiety, suffocative asthma, &c, whilst the func- 
tion of the brain is unimpaired, there is proof that an im- 



ITS PATHOLOGY — PROXIMATE CAUSE. 151 

pression is thrown upon the solar plexus and the par vagum, 
which are closely connected together, and produces the par- 
tial death of those nerves, called with much justice abdominal 
paralysis or apoplexy"* 

Examples of a similar kind will be found in Sir C. Bell's 
work upon the nerves. 

Many poisons operate so swiftly as to make it almost cer- 
tain that they act through the nerves. Magendie, speaking 
of the effects of pure hydrocyanic, compares it in point of 
swiftness to a thunderbolt. Dr. Christison was unable to 
detect an appreciable interval between the moment when 
conia, the active principle of hemlock, was inserted into the 
leg of a dog, and that in which the animal died.-|- The poi- 
son of some kinds of serpents is also very rapid* Russell, in 
his treatise upon Indian serpents, mentions the case of a 
servant girl who was bit by a species of boa, and died in 
ten minutes after the wound was inflicted.j The resem- 
blance between the effects produced by bites of poisonous 
snakes and cholera is so striking, that Mr. Coates, in his 
Report to the Medical Board of Bombay, says, " I should 
have pronounced that some of my patients (with cholera) 
had been labouring under snake-bites, had I not been better 
informed/' § 

The remarkable general resemblance between cholera and 
the plague must strike every one who attentively considers 
the phenomena of both. The following are the heads given 
in Russell's History of the Plague of the various symptoms : 
Fever, delirium, coma, impediment or loss of speech, deaf- 
ness, muddiness of the eyes, white tongue, state of the pulse, 



* Lobstein on the Sympathetic Nerve, pp. 122, 123. 

f Christison on Poisons, p. 8. 

% See Orfila on Poisons, vol. ii. p. 402. 

I Reports on the Epidemic, p. 153, quoted by Or ton. 



152 ON EPIDEMIC CHOLERA. 

respiration, anxiety, pain at the heart, inquietude, debility, 
faintness, convulsion, appearances of the urine, perspiration, vo- 
miting, looseness, and haemorrhage. The symptoms registered 
under many of these kinds are common to plague and cholera, 
and the points of likeness are more important than those in 
which they differ. We have mentioned the almost constant 
complaint that cholera patients make — of anxiety, and of 
something being wrong at the heart. So striking a symptom 
of cholera is this, that Dr. Markus, who saw a great deal of 
the disease in Moscow, considers the heart as the primary 
seat of the disease, and gives a curious comparative table of 
" the symptoms of cholera and those of the morbid affections 
of the heart." * In the plague, says Russell,^ " the sick 
showed how severely they suffered, by perpetually changing 
posture in hopes of relief ; but when asked where the pain 
lay, they either answered hastily they could not tell, or, with 
a fixed, wild look, exclaimed, Kulbi ! Kulbi ! (My heart ! 
My heart !)" 

Is it not probable that the plague is produced by a poison 
acting, as well as the cholera poison, upon the ganglionic sys- 
tem of nerves, being conveyed to the seat of these nerves 
through the medium of the respiratory apparatus, and pro- 
ducing symptoms so far resembling cholera as the primary 
seat of the disease is similar, and so far differing as the ex- 
citing cause of the two is different ? 

To conclude, all we can say is, that of the many hypothe- 
tical causes suggested as the proximate cause of cholera, a 
morbid action in the ganglionic system of nerves seems to 
us by much the most probable and satisfactory. 
* Op. cit, p. 80. f Op. cit., p. 88. 



ITS PATHOLOGY— MORBID ANATOMY. 153 



MORBID ANATOMY. 

The morbid anatomy of cholera has been investigated by 
many able pathologists, and on the whole there is a great 
concurrence in the description of the appearances found on 
dissection. We may begin with the observations upon the 
cholera in India. Mr. Scot says:* — " The external appear- 
ance of European subjects who have sunk under cholera, 
closely resembles that which has been noticed as taking 
place during life. The surface is livid, the solids are shrunk, 
the skin of the hands and feet is corrugated. There seems 
no sufficient evidence of any uncommon tendency in the body 
to putrefaction after death, nor of any characteristic fcetor 
from the abdominal cavity. No particular morbid appear- 
ances have been found in any of the cavities of the body, 
which are lined with serous membranes, or in these mem- 
branes themselves. The cavities of the pleura, of the peri- 
cardium, and of the peritoneum, have almost uniformly been 
found in a natural state, or the deviations from that state 
have manifestly had no connexion with cholera. The surfaces 
which are lined or covered with mucous membranes, have, on 
the contrary, very generally exhibited signs of disease. 
These will be noticed, as the organs connected with them 
come to be mentioned. 

" The lungs have not unfrequently been found in a natural 
state, even in cases where much oppression of respiration 
had existed previously to death. Much more generally, 
however, they have been found either to be gorged with 
dark blood, so that they have lost their characteristic ap- 
pearance, and have assumed more that of liver or spleen ; 
or they have been found to be in the opposite state — that 
is, collapsed into an extremely small bulk, and lying in the 
, * Op. cit., p. 69. 



154 ON EPIDEMIC CHOLERA. 

hollow on each side of the spine, leaving the cavity of the 
thorax nearly empty. This appearance has been so remark- 
able as to induce Dr. Pollock, of H. M. 53d regiment, to con- 
ceive, that it could only be produced by the extrication of a 
gas within the cavity of the pleura, capable of overcoming the 
atmospheric pressure. It is understood, however, that op- 
portunities were had of piercing the thorax of the dead body 
under water, and that no gas was extricated. As there 
appears to have been an absolute vacancy in the cavity of 
the pleura, (that is to say ? the lungs did not by any means 
fill it,) it would seem that that viscus had exerted a con- 
tractile power, adequate to overcome the pressure of the 
atmosphere. The blood found in the lungs has been always 
very black. The heart and its larger vessels have been found 
to be distended with blood, but not so generally as the ap- 
parent feebleness of their propelling power, and the evident 
retreat of the blood to the centre, would have led us to ex- 
pect. The right auricle and ventricle being gorged with 
blood, is nothing peculiar to cholera ; but some dissections 
have shown the left cavities to be even filled with dark or 
black blood, which we may reckon as a morbid appear- 
ance more peculiar to it. In the abdominal cavity, the peri- 
tonial coverings of the viscera, being serous membranes, pre- 
sent in general but little deviation from the healthy state ; 
occasionally, indeed, the morbid accumulation of blood in 
the vessels of the viscera, imparting an appearance of tur- 
gidity and blueness, is evident on their exterior surfaces. 
We also find them bearing marks of inflammation, especially 
where the patient may have lingered long before death. In 
other cases, the whole tube has had a blanched appear- 
ance, both externally and internally. The stomach and in- 
testines generally preserve their ordinary volume. The ap- 
pearance of the omentum is not sensibly affected in cholera. 



ITS PATHOLOGY— MORBID ANATOMY. 155 

The stomach is found to be so variously affected as to de- 
stroy all grounds for pathological reasoning. It is. very 
rarely found empty or much contracted after death, nor has 
any appearance of spastic stricture of the pylorus been often 
detected. It has, however, sometimes occurred. Its contents 
appear to be chiefly the ingesta in an unaltered state : in 
some cases, greenish, or yellow, or turbid matters are found. 
The stomach has been said to have been found ' lined with 
calomel/ Various appearances, either of active inflammation 
or a congested state of the vessels, have been noticed, some- 
times in one part, sometimes in another. The parts seem as 
if they were sphacelated, thickened, softened, and friable ; 
and, in short, exhibit so great a variety of appearances, from 
a perfectly natural state to the most morbid, that no parti- 
cular light is thrown by them on the disease. 

" The intestinal tube is sometimes collapsed, but oftener 
found to be more or less filled with air, distended in some 
parts into bags or pouches, containing whitish, turbid, dark, 
or green-coloured fluid, and in others presenting the appear- 
ance of spastic constriction. The latter, however, is not 
common. No fecal or other solid matters are found in the 
intestines, but very commonly large quantities of the congee- 
looking fluid, or of turbid, serous matter. The duodenum, 
and occasionally the jejunum, have been found loaded with 
an adherent, whitish or greenish mucus ; at other times 
they have been found seemingly denuded of their natural 
mucus, and often perfectly healthy. Traces of bile in the 
intestines, or of any substance apparently descended from the 
stomach, are exceedingly rare. Sanguineous congestion, and 
even active inflammation, are stated to be more common in 
the bowels than in the stomach ; but, on the other hand, in- 
stances are very numerous where no such indications have 
been detected. The thoracic duct is stated to have been 



156 ON EPIDEMIC CHOLERA. 

empty of chyle. The liver has been commonly found to be 
gorged with blood, but not always : it is an organ usually 
very vascular; and it would probably demand a nicer dis-~ 
crimination than has been bestowed on the subject, to dis- 
tinguish the degree of congestion in which it is naturally 
left by the settling of the blood after death in ordinary dis- 
eases, from that which has been observed after an attack of 
cholera. The gall bladder has almost universally been found 
to contain bile, and, in the great majority of cases, even to 
be completely filled with it. As is usual with this secretion 
in cases of retention, it is of a dark colour. Very different 
states of the gall ducts have been described — cases of con- 
striction and impermeability seeming to be equally numerous 
with those of an opposite character. 

" The urinary bladder is found, we may say universally, 
without urine, and very much contracted. The lining or mu- 
cous membranes of the bladder and ureters have been found 
coated with a whitish mucous fluid. The appearance of the 
spleen, which is so various under the ordinary conditions of 
the body after death, has indicated nothing that can be 
mentioned as belonging to cholera. The vessels of the me- 
sentery have been very generally found to be uncommonly full 
of blood. In the head, appearances of congestion, and even 
of extravasation, have been frequently observed, but not so 
uniformly, nor to such extent as to require any particular 
notice. Only one case has been given, where the state of 
the spinal marrow was examined, and in that, indications of 
great inflammation were detected in its sheath ; the case, 
however, was in some degree a mixed one/' 

The next quotation is from a paper by M. Victor Bally, 
which appeared in the Memoirs of the Royal Academy of 
Medicine, and has been partially quoted in the fourth number 
of the British and Foreign Medico-Chirurgical Review, from 



ITS PATHOLOGY — MORBID ANATOMY, 157 

which we heave made the following extracts. M. Bally had 
extensive opportunities of investigating the subject at the 
Hotel Dieu of Paris. 

He divides the disease into the cyanic and reactionary 
period, and the following description is of those who died in 
the former stage : — 

" The surface of the body. — The cyanosis, which may oc- 
cur at very different periods prior to death, is not the result 
of engorgement, but of a deprivation of the watery parts of 
the blood. It is very variable in extent and intensity, and 
difficult of exact pictorial delineation. It is rare to find it 
quite uniform and general. In the algide form of cholera, 
it is by no means rare to find portions of the body having 
after death a higher temperature than they possessed during 
life. The cadaveric odour was long in becoming developed ; 
a strong smell from some of the remaining alvine discharges, 
resembling the odour of the pollen of the chesnut-flower, 
was, however, observable. This smell was often strong and 
remarkable ; and although it was also very perceptible on 
opening the intestines, it in nowise resembled that of faecal 
matters. The fasces, too, were long retained without under- 
going putrefaction. Otto of Breslau exposed the bodies of 
an old man and young woman dying of cholera for three 
days to the rays of the sun, and yet was the rigidity as great 
as at first, no putrefaction having occurred. The emaciation 
was as remarkable during the short space of time that 
elapses in cholera, as it is in the longer one of phthisis ; and 
the bodies of the patients were lifted by the dissecting-room 
attendants with astonishing facility. The very singular con- 
dition of the skin was sometimes observed, termed by the 
author empdtement. In well-marked cyanosis, it might be 
seen towards the decline of life ; but then the skin, if pinched 
up, would slowly, by its elasticity, resume its form. After 



158 ON EPIDEMIC CHOLERA. 

death, however, it remained as placed, just as would so much 
moulded clay. The skin of the fingers was thus thrown 
into plaits without the mechanical intervention of any 
foreign body. The author explains the occurrence by the 
removal of the aqueous portions of the blood from the cuta- 
neous capillaries, leaving only a pasty plastering on their 
surface; and -he believes this passive condition of the skin 
to act as a preservative against the communication of the 
disease by contact — differing so entirely as it does from the 
turgescence of the surface observable in yellow fever. The 
skin of the forehead, which was violaceous, pasty, and plait- 
ed prior to death, had frequently recovered its natural colour 
when the body was brought in for dissection. In this 
disease, says A. Beclard, the living resemble the dead, 
and the dead the living. In respect to the eyes, M. Bally 
observes : — 

" ' Who does not recollect the frightful aspect of the un- 
fortunate beings suffering under the algide period? How. 
astonished and stupified their air, what uncertainty in their 
looks ! Was ever a more painful spectacle seen than the 
globes of the eye coloured by numberless delicate arboriza- 
tions, often giving rise to bloody patches ; or those horrible 
stigmata blackening the sclerotica exposed to view by the 
convulsive expansion of the eyelids? The sclerotica, too, 
acquired a demi-transparency due to its partial desiccation, 
which allowed the blackness of the choroid to be seen 
through it. During the apogee of this period, a rapid disap- 
pearance of the fat of the orbit, and a notable resorption of 
the aqueous humour of the two chambers and of the interior 
of the tissues took place. At the same time, the muscles, 
finding no longer the same resistance in a globe so dimin- 
ished in volume, drew back the organ into the very depths 
of the orbit. It might be said, and the remark would apply 



ITS PATHOLOGY— MORBID ANATOMY. 159 

to the entire organism, that the whole of the powers and 
actions of the economy exerted no longer any other effect 
than that of emaciating the body/ (Tom. xii. p. 166.) 

" The conjunctiva is sometimes entirely reddened, just as 
is observed in yellow fever, only in this last disease the 
black spots are not seen. The iris becomes dull, and loses 
all harmony in its movements, being drawn in a great variety 
of directions, and enlarged either transversely or vertically, 
instead of circularly, ' whence results the fact that this 
organ, as in the feline race, acts irregularly and unequally ; 
and indeed some portion of its fibres may be considered as 
attacked with partial paralysis, or perhaps with fibrillary 
convulsion, as is observed in the muscles/ The altered con- 
dition of the circulation of the eye, the irregularity of its 
movements, and the change in its bulk, explain the peculiar 
look, the loss of sight, and the hallucinations, of cholera 
patients/' 

" Alimentary canal. — The mouth is dry, and in no other 
disease do the lips remain so separated after death, owing to 
the rigidity consequent on prior convulsive action. The 
teeth lose their whiteness and brilliancy, acquiring a bluish 

or reddish cast The tongue, so extremely cold 

during life, is less so after death, and is smaller in size 
than natural. The fungiform papillae at the base are much 
developed. The salivary glands, though unaffected by 
morbid processes, yet cease to perform their natural func- 
tions — this being one of the causes of the intense thirst 
suffered by the patient. The follicles of the oesophagus 
are sometimes developed, especially towards the cardiac 
orifice. The appearances observed in the stomach are de- 
scribed very minutely. Some portions of the organ were 
observed of a dull white, just as in ramollissement, the tex- 
ture, however, remaining firm. In other cases, spots of 



160 , ON EPIDEMIC CHOLERA. 

ramollissement did exist. The abnormal development of the 
capillary vessels filled with blackened blood, has given rise 
to the erroneous belief of the existence of gangrene. Gas- 
tritis, too, except to a very limited extent in exceptional 
cases, is not found during the cyanic period. Three groups 
of lesions, independently of altered colour, were observed : — 
1. Granules with no contents. 2. Pyriform granulations, 
containing a white, albuminous, purulent-looking substance, 
this being sometimes fluid, and oftener so thick as not to 
pass out even after the incision of the granule. 3. The 
mucous membrane was penetrated, and especially at the 
great cut de sac of the stomach, by numbers of minute holes 
or depressions visible to the naked eye. When death took 
place in the algide period, the external appearance of the 
intestinal canal was most remarkable, so deeply coloured was 
it by the network of vessels — ecchymosis sometimes result- 
ing from the great afflux of blood. 

" ' Not that the capillaries remained filled. They were so 
when an unusual, extraordinary, and prodigious afflux con- 
verged towards this point ; and they remained coloured and 
varnished, by the red portion of the blood separated from 
the colourless portion. They constituted a new order of 
organs, usurping functions which were not their own, and 
invading, in the full force of the expression, those of other 
organs. The intestine thus became transformed into a re- 
paratory and secreting agent, which exhaled and allowed the 
transudation of white blood ; and if globules became mixed 
with this intestinal sweat, then the albuminous lymphs was 
rose-coloured, the villi ceased to absorb, and the functions of 
the other secreting organs of the body were no longer per- 
formed/ (Tom. xii. p. 199.) 

" Automatic movements. — At the instant of the extinction 
of life a rapid movement of the lips was observed (marmo- 



ITS PATHOLOGY — MORBID ANATOMY. 161 

tage), exactly resembling that which takes place in some 
persons while reciting their prayers. It continued a short 
time after death, and at the same time movements of the 
forearm were observed. These first produced pronation, 
which was slowly but with complete regularity followed by 
supination — such alternation continuing even for several 
minutes. If great care in observation had not been used, 
it might easily have been believed that these meteoric mo- 
tions of the lips and arms were directed by consciousness. 
Frequently, a vermicular or oscillatory movement of the mus- 
cles of the thorax was discernible. 

" The Nervous System. — In several cases the sinuses of the 
brain were found remarkably empty ; and the veins of the 
pia mater were swollen up, though containing but little 
blood. The membranes of the brain were not found in the 
congested state described by some Indian practitioners ; both 
the arachnoid and pia mater retained their transparency, the 
former containing no fluid, and manifesting some of the 
stickiness perceived in the pleura. The ventricles, too, con- 
tained less fluid than in the normal state, and the substance 
of the brain did not exhibit bloody points on section. The 
spinal marrow was examined in almost all cases, and found 
in a natural condition, its veins, however, being swollen and 
pursed up, without any turgescence from blood, and contain- 
ing (the author supposes) rarefied air. The various nerves 
and ganglia were examined, without furnishing any particu- 
lar results/' 

Professor Lizars of Edinburgh, in a pamphlet republished 
last year, containing his observations upon the anatomical 
appearances of persons who died of cholera, gives the follow- 
ing summary of the examination of the ganglionic system 
of nerves in seventeen cases : — 

" In ten, the neurolema of the pneumogastric nerves was 



162 ON EPIDEMIC CHOLERA. 

injected with blood-vessels ; in one, the nerve was enlarged ; 
in another, it was thickened ; and in a third, the neurolema 
was inflamed with ecchymosed patches. 

" In six, the neurolema of the splanchnic nerves was vas- 
cular ; in two, the ganglia at their origins were vividly in- 
jected ; and one ganglion was ecchymosed. 

" In sixteen, one or both of the semilunar ganglia were 
vascular ; in one, it was inflamed ; in three, it was enlarged 
and infiltrated w T ith blood or serum ; and in two softened. 

" In eight, the solar plexus was highly vascular through- 
out ; in three, the ganglia and nerves were enlarged, and 
one infiltrated. 

" In four, the renal plexus was very vascular. 

" In four, the oesophageal plexuses were vascular. 

" In one, the recurrent of the pneumogastric nerve was 
vascular. 

" In five, the cardiac plexus was enlarged and very vas- 
cular/'* 

Mr. Lizars is a most competent authority in anatomical 
matters, although his observations require confirmation. We 
shall conclude this department of our subject by a trans- 
lation of Dr. Miiller's summary of the pathological appear- 
ances observed in the recent epidemic, and which are de- 
rived from upwards of six hundred dissections of cholera 
subjects : — 

Petersburgh, August 1848. 

Membranes of the Brain. — Usually congested, but more 
frequently (edematous : the vessels of the dura mater filled 
with coagula of black unctuous blood ; the dura mater at 
the base of the skull almost completely black-blue, (from the 
stagnation of the blood in all the vessels.) On removing 
the brain, there generally gushed out a great quantity of 

* Page 46. 



ITS PATHOLOGY — MORBID ANATOMY. 163 

clear, or sometimes red-coloured serum, which also poured 
from the spinal canal. 

Brain. — Constant and unusually developed hyperemia ; 
all the vessels are distended with the contained blood. The 
injection appears to have supervened when a previously ex- 
isting congestion was at its height, and was particularly 
well seen on the under surface of the corpus callosum. To- 
gether with this, oedema of the brain, (Gehirn-cedem.) On 
separating the membranes, which is always easily accom- 
plished, a quantity of serum flows out ; the ventricles of 
the brain are more or less filled with serum, and even dilated 
in cases of prolonged duration of the disease. The sub- 
stance of the brain is, in general, tenacious and firm, and of 
a peculiar and remarkable white colour, (most excellent spe- 
cimens for anatomical study.) This state existed equally in 
all the cases examined, whether death had occurred after a 
few hours or several days. In the commencement of the 
epidemic, there occurred cases in which the brain was flabby 
and soft, but only in such patients as sunk in a few hours, or, 
for the most part, in a very short time. In a few instances, 
and particularly towards the end of the epidemic, meningitis 
made its appearance, with extensive purulent exudations. 

Hypersemia of the spinal marrow, which was at the same 
time firm and tenacious ; a quantity of serum in the arach- 
noid sheath ; in the spinal canal distention of the veins with 
blood. There occur frequently in the arachnoid small par-, 
tides of cartilage of this form ^ ; at Moscow, this appear- 
ance, which indeed may often be observed, was declared to 
be characteristic of cholera. 

Throat. — Swelling of the mucous glands at the base of the 
tongue, (which are hard and bluish-red) ; mucous mem- 
brane of the oesophagus and larynx dark-red, from the inac- 
tivity of the venous system, nothing besides. 



164 ON EPIDEMIC CHOLERA. 

Thoracic cavity. — In the majority of cases always at the 
commencement of the epidemic, and in all patients who 
sank rapidly, a peculiar unctuous feeling (like white of egg 
or isinglass) in the pleural sack, and in a less degree in the 
pericardium. 

Heart — Full of fluid blood, or else black unctuous clots 
(generally) ;' also in many cases tough fibrinous coagula ; 
very often larger or smaller spots of ecchymosis on the peri- 
cardium ; besides which there was nothing remarkable, ex- 
cept a great flabbiness of the muscular substance. 

Lungs. — Remarkable anaemia of the capillary system in 
the substance of the lungs, while black thick blood poured 
in greater or less quantity out of the larger vessels. The 
lungs are pale and whitish, and very dry to the touch. When 
patients die after reaction has set in, those dark spots may 
be already observed, scattered through the anaemic lung, 
though in a very slight degree, which are observed in the 
beginning of hypostatic pneumonia or acute oedema. When 
death occurs later there is very often more extensively dif- 
fused oedema of the lungs, or completely developed hypo- 
static, and for the most part lobular pneumonia, with soft 
red hepatization. 

Abdominal cavity. — Capillary system of the liver anaemic ; 
in the larger vessels at times a quantity of blood, at others 
very little. The liver presents but little to be remarked. 
,The gall-bladder in general filled to distention with blackish, 
tough, and unctuous bile. In cases that had advanced 
slowly, and in which the contents of the intestine showed the 
admixture of bile, the gall-bladder was flaccid, or even en- 
tirely empty. 

The Spleen small, and its capsule wrinkled ; besides which, 
it presented nothing abnormal, excepting where it had be- 
come degenerated from previous attacks of intermittent 



ITS PATHOLOGY — MORBID ANATOMY. 165 

fever, a common consequence of this disease. In complica- 
tion of cholera with typhus, the spleen was slightly enlarged, 
as in pure typhus, (very distinctly marked.) 

Stomach. — The mucous membrane friable and soft, and 
exhibiting very often spots of ecchymosis. In a third of all 
the cases, undigested food was found in the stomach. 

Small intestine. — At the commencement of the epidemic, 
very anaemic; yet, judging by the condition of the swollen vasa 
subserosa, which in some instances appeared as white, bloodless 
cords, and in others distended with blood, a state of hyper- 
emia might be detected, as having immediately preceded. 
At a subsequent period, throughout the entire small intestine, 
and particularly in the jejunum, a remarkable hyperaemia 
was perceptible, and in protracted cases even pure blood was 
thrown out (resembling bloody mucus.) An enlargement of 
all the solitary glands, and the glands of Peyer, or rather an 
engorgement of the adjacent villous coat, and of the entire 
circumference of the intestine, took place to an extent that 
is not observed in any other disease. Over the groups of 
Peyer's glands this engorgement presented the deceptive 
appearance of an exudation: the microscope, however, 
showed the villi, and microscopic injection of the vessels 
confirmed this. On drying such a piece of intestine, there 
merely remained at the destroyed spot a whitish point, as 
the contents of a solitary gland. Throughout the small in- 
testine the epithelium was abraded, yet it covered in part, 
like a tough coating, the subjacent mucous membrane. With 
these changes there was always present the peculiar, pasty, 
greyish-white, flocculent cholera secretion of the intestine, 
(having an acid reaction, and containing a quantity of albu- 
men.) Entire flakes hung down from the mucous membrane 
of the intestine, and presented the appearance of a slough, 
which, if squeezed out, proved under the microscope to be 



166 ON EPIDEMIC CHOLERA. 

epithelium. In other cases, but always associated with 
separation of the epithelium, appeared regular ileitis, % the 
contents of the intestine being bloody ; when the progress 
was slower, the first stage of the typhoid process was fre- 
quently observable in the neighbourhood of Peyer's glands, 
and in the entire lower part of the ilium, with the peculiar 
punctiform -arrangement of the typhous formation, without 
arriving at actual ulceration. But in other cases there was 
ulceration and detachment of the mucous membrane in large 
spots, then discoloration and destruction of the mucous 
membrane and ecchymosed spots of greater or less extent. 
In cases where there was hypostatic pneumonia, the villi 
had disappeared at distant intervals, and the intestine ap- 
peared quite smooth in some places, while in others it might 
be perceived to be rough. 

Large intestine. — At the commencement anaemia, the 
mucous and muscular tissues unusually folded, (whereby the 
volume is diminished,) and covered with a sloughy grey 
paste, which consisted of mucus and abraded epithelium. 
When the progress is slow, there is considerable hyperemia, 
with a variable number of spots of ecchymosis occupying 
either part, or the whole of the intestine. The intestine in 
that part looked smooth and red, as if blood had been 
smeared on the surface of the mucous membrane. The 
patches of abraded epithelium, which are here of greater 
extent than in the small intestine, cannot be removed by the 
pouring on of water, and usually disclose, on being peeled 
off, an ecchymosed state of the mucous membrane. In seve- 
ral rare cases, there was observed, particularly in the sig- 
moid flexure and rectum, isolated patches of grey exuda- 
tion, which in some places exhibited black spots, or large 
expanded scablike patches ; on being examined with the 
microscope, however, although much altered in character, 



ITS PATHOLOGY — MORBID ANATOMY. 167 

blood corpuscules were perceived. When this was removed 
with the knife, ecchymosed spots were again found. 

Next occurred the various grades of diarrhceic and dysen- 
teric ulceration. 

Mesenteric Glands. — In all those acute cases where true 
cholera discharge existed in the intestinal canal, and the 
peculiar solitary villous development and abrasion of the 
epithelium, the mesenteric glands presented an enlargement 
both characteristic and peculiar. They were swollen and 
infiltrated as in typhus, but of a pale yellow colour, like 
what is called herring-milt. 

The urinary and sexual system exhibited nothing par- 
ticular. 

The Peritoneum had a distinctly greasy feel like the 
pleural sack, so that the fingers were actually stuck together 
by it. 

Cases that had run their course rapidly always exhibited 
a very dark-coloured, wrinkled, and withered state of the 
skin, and were distinguished by a high degree of muscular 
rigidity. 

It was observed that in the vast number of bodies exa- 
mined not a single case of acute tubercular disease, which is 
generally so common in Petersburgh, was met with. This 
very important and interesting observation coincides with the 
statement of Professor Roketansky of Vienna, who noticed 
a similar immunity from cholera on the part of patients in 
acute phthisis. 



lf«t§^ 



* 



168 ON EPIDEMIC CHOLERA. 



CHAPTER 1Y. 

ITS SYMPTOMS. 

The most elaborate and accurate detail of the symptoms 
of cholera must fail altogether to give a just idea of the ap- 
pearance presented by the disease ; for even supposing that 
the terms used by the describer were so appropriate as to 
convey to the mind of another the exact notion which was 
in his own, yet there would still be this immense difference 
between them, that the reader would only acquire gradually 
the impression of the various phenomena which the beholder 
receives instantaneously. Although this remark applies 
more or less to all descriptions of diseas^ as contradistin- 
guished from their actual observation, yet it is peculiarly 
applicable to the one we have now to do with, for in it there 
is a combination of an unusual number of symptoms. It is 
unlike all diseases we have ever beheld in this respect — that 
it fills the mind with a sense of horror. Many other maladies 
are far more painful, more deadly, some as rapid, many more 
loathsome ; but none are so full of horror. And this sen- 
sation is quite irrespective of our knowledge of the probable 
termination of the attack. The reason of this seems to us to 
be this : — Disease in all its other forms attacks the person ; 
we can distinguish the two, so to speak — we see the combat 
going on ; but the cholera seems to annihilate personality. 
What was a few hours before a warm, living, human vesture 
of the soul, by means of which it linked itself to other living 



C 9W. 



ITS SYMPTOMS. 1 69 

beings, is suddenly changed into cold, damp, dead flesh. The 
bond of union is converted into an impassable barrier. There 
is no more sympathy between it and a living man than if it 
were in reality a corpse ; and yet the mind is clear, confined 
though it be in this cold prison. In one word, we feel as if we 
were holding intercourse with a haunted corpse. To those 
who never saw a case of cholera, this may seem an absurd 
exaggeration ; but we do not think that any one who has 
come in contact with the disease in its most appalling form 
will accuse us of overstating the feeling of horror which 
came over him when he saw the cholera for the first time. 
However inadequate any description may be to convey a full 
idea of the disease, yet it is essential that we should have as 
accurate a register as possible of the various symptoms, that 
we may be able to discover the most suitable remedies. 

There are four stages of the disease which it is important 
to distinguish. First, the invasion; second, the collapse; 
third, the reaction; fourth, the consecutive fever. It maybe 
a question whether the last should be spoken of as a stage 
of cholera, and not rather as a consequence of the disease, 
which judicious treatment may in a great measure prevent. 
However, for practical purposes, it is no matter whether we 
regard it as the last stage of cholera, or as the first stage of 
a new disease which cholera alone gives rise to. 

In detailing the symptoms of the various stages, we shall 
follow the method we are in the habit of employing in mak- 
ing a register of a Case, as it has many conveniences, and is 
besides familiar to all homoeopathic practitioners. 

The general symptoms of the invasion of cholera are rapid 
prostration of strength ; inability to sit or stand ; languor ; 
vertigo on rising ; restlessness ; general uneasiness ; pains 
throughout the whole body ; soreness of the body. 

The skin is colder than usual, and moist, or dry and cold. 



1 70 ON EPIDEMIC CHOLERA. 

Fever. — Chilliness, shivering, trembling, and chattering of 
the teeth. Pulse rapid, soft, and full, intermittent. 

Moral symptoms. — Great anxiety and depression of spirits. 

Head. — Pain in the head ; vertigo. 

Eyes. — Dark circle round the eyes ; eyes dull. 

Ears. — Noise in the ears. 

Face. — Pale and anxious ; sometimes cold ; expression 
uneasy and peculiar. 

So remarkable is this change of expression, that in India 
servants can scarcely be recognised by their masters, even in 
the early stage of the disease. Mr. Annesly, who is a great 
authority on the subject, says : — " A practitioner, possessed 
of true professional tact, will discover in the countenance of 
the patient the earliest changes which mark the approaching 
invasion of the disease/' * 

Mouth. — Tongue w r hite, loaded, covered with a yellow fur. 

Appetite. — Great thirst ; nausea. 

Stomach. — Nausea and vomiting ; pain at epigastrium. 

Abdomen. — Pain in abdomen ; soreness ; tenderness on 
pressure ; pain below umbilicus ; griping of the bowels. 

Fceces. — Heat in ano ; suppression of stools ; constant in- 
effectual desire to pass stools ; loose stools of a natural colour, 
or dark brown, or greyish. 

Urine. — Ineffectual desire to urinate ; urine pale. 

Chest — Oppression of chest. 

These are the chief symptoms met with in the first stage, 
or the invasion of cholera ; but of course they are not all 
present in every case, some are much more constant than 
others. We should feel inclined to consider the following 
group to be pathognomonic : Sudden sense of illness, giddi- 
ness, nausea, perhaps vomiting, a great change in the ex- 

* Reports on the Epidemic Cholera, published by the Medical Board of Bom- 
bay — Preface. 



ITS SYMPTOMS. 171 

pression of the countenance, a rapid intermittent pulse, 
especially if the patient has been particularly exposed to the 
choleraic influence, and if there is no other explanation of 
the symptoms. For we may here observe, that during the 
prevalence of cholera, hysterical females often are affected 
by a train of symptoms very like the disease, but in reality 
only an imitation of it, and not attended with danger. It 
requires great tact to distinguish this unconscious feigning 
from an attack of real cholera. 

The first stage is probably never fatal in this country, but 
in India we are disposed to believe that it may be so. In- 
stances are on record of the natives being suddenly attacked 
with giddiness when walking in the open air, and after hav- 
ing retched a little, they expired in a few minutes. A native 
tailor at Bellary is said to have expired instantly with his 
work in his hand, and in the very attitude in which he sat 
when attacked by what was believed to be cholera. At Pun- 
derpoor three hundred and fifty people are described to 
have died in one day, tumbling over each other lifeless on 
the public streets. In a few days, says another writer, the 
deaths were estimated at three thousand, and the patients 
are described as having been knocked down dead as if by 
lightning. 

The first stage, when not fatal and not checked by its ap- 
propriate specific — and we cannot too soon or too often state 
our firm conviction, that this stage is in the vast majority of 
cases curable by a specific medicine, and that upon the timely 
administration of this medicine hangs the fate of thousands 
during the prevalence of the epidemic — if neither fatal nor 
unchecked, it soon passes into the second stage, or stage of 
collapse. The symptoms of this stage are numerous and well 
marked, although it presents a great variety of forms, so 
that we scarcely remember two cases precisely alike. We 
shall employ the same classification as before. 



■s&ir&'p , -i?!?&r' r &. *^^^Sf^f ?->~;l 



172 ON EPIDEMIC CHOLERA. 

General Symptoms. — Rapid prostration of strength ; stiff- 
ness of the muscles ; the body suddenly becomes stiff, blue, 
and cold ; violent cramps of the muscles of voluntary motion ; 
cramps so painful as to make the patient roar out, sometimes 
force him out of bed ; violent convulsive fits, lasting from 
five to ten minutes, with fixed eyeballs, clenching of the jaws 
and slight foaming at the mouth ; violent starting fits, as 
if from fright ; several fainting fits in rapid succession. 

The spasms are sometimes so violent and general that 
the patient looks as if ill of tetanus. We were told by a 
physician of high authority in all matters regarding cholera, 
that he was once taken to see a lady who was said to have 
tetanus. He found her in the state of opisthotonus or empros- 
thotonus, we forget which, but one of the two, her body 
forming a complete arch, and the medical attendants sorely 
surprised. From the expression of the countenance he diag- 
nosed cholera, and bled her. The spasms immediately 
subsided, and vomiting and purging, with the other unmis- 
takable symptoms of the disease, set in. She recovered not- 
withstanding the bleeding. To continue our catalogue : — 

Skin. — Cold and livid ; covered with clammy perspiration ; 
dark -blue ; shrivelled ; feels like soaked leather. 

" The sensation imparted by touching the skin of a person 
ill with cholera is very peculiar, and reminds one of that 
imparted by a dead body. The skin when much collapsed, 
becomes insensible even to the action of chemical agents, 
and hence the usual vesicatories fail in producing any effect. 
The application of mineral acids and of boiling water, in 
this condition of the skin, produces little or no effect, and 
some patients are said not to have been sensible of the 
operation. The action of mineral acids on the skin is not, 
however, vesication, but rather that of a cautery ; the 
cuticle, and the extremities of the subjacent vessels, appear- 
ing to be destroyed by them. It has been said that vesica- 



ITS SYMPTOMS. 173 

tion could not be produced in some stages of cholera, because 
the production of serum was, in common with the glandular 
secretions, arrested ; but when we reflect on the readiness 
with which serous fluids are poured out in that disease, we 
shall be rather disposed to refer the failure in the action of 
vesicatories, even of hot water, to the diminution or destruc- 
tion of the nervous energy of the skin. It is certain that, 
in a body but just dead, the application of boiling water 
will vesicate readily ; and if the accuracy of the obser- 
vation respecting its non-vesicating power in advanced 
stages of cholera be established, we must infer that there 
is less vitality in the skin in such cases, the patient being 
still alive, than in that of a body recently dead of some 
other disease. 

" At a very early stage in cholera, leeches can procure 
little or no blood from the skin. This fact is noticed by 
some in another sense, as if these animals turned in abhor- 
rence from the skin of a person ill with cholera. When the 
sweat is thin, it is usually poured out, in large quantity, 
from the whole surface of the body ; but when thick or 
clammy, it is more partial, and generally confined to the 
trunk and head. The action of the vapour, and hot baths, 
seem unquestionably to increase the exudation, or secretion 
from the skin ; and the application of dry heat, as the natural 
temperature of the skin augments, appears to restrain these 
discharges — circumstances not very compatible with the sup- 
position of a state of spasm of the vessels of the skin. The 
perspiration or moisture is often free from odour ; at other 
times it has a fetid, sour, or earthy smell, which has been 
said to be peculiarly disagreeable, and to ' hang long about 
the nostrils' of the by-stander." * 

Fever. — Pulse like a fine thread; imperceptible in one 
wrist, barely perceptible in the other ; quite imperceptible ; 
* Scot, op. cit. 






174 ON EPIDEMIC CHOLERA. 

when again felt, very small and quick, so that it cannot be 
counted. 

Moral symptoms. — Great anxiety ; inquires anxiously 
whether she will recover ; afraid of instant death ; begs us 
not to leave her or she will die ; despair of recovery ; cries 
out, " I am dying : I cannot live/' 

Head. — Vertigo ; headach ; noise in the head. 

Eyes. — Eyes sunk, open, glassy ; eyeballs leaden-coloured ; 
eyes inflamed. The affection of the eye is peculiar and 
characteristic, so that it is sometimes called by the natives 
of India the " red-eye sickness/' Mr. Scot* gives the fol- 
lowing account of what he himself observed : — " While look- 
ing earnestly into the countenance of a patient, I saw the 
vessels of the conjunctiva deeply injected with blood in a 
moment of time. I was able distinctly to trace its progress : 
it was arterial blood, propelled in a jet from the back part 
of the globe of the eye, forward to the verge of the cornea, 
presenting that appearance sufficiently known in cholera, 
and which has led the natives of India to denominate it as 
the ' red-eye sickness/ " 

Ears. — Noise in the ears ; deafness. 

Face. — Cold ; livid ; blue ; pale and anxious ; sunk and 
ghastly ; expression uneasy, wild, of terror ; dejected ; hag- 
gard ; features contracted and sharpened ; cold perspiration 
in face ; twitching of the muscles of the face. 

Mouth. — Dark areola round the mouth ; lips cold and 
flabby ; tongue bluish, cold, flabby, and moist ; feels like a 
piece of raw meat. 

Throat. — Sensation of choking ; inability to swallow. 

Appetite. — Insatiable thirst. " Intensissima sitis." 

In one instance, a poor woman drank all the water out of 
a bottle of hot water put at her feet to warm them. The 
intense thirst was one of the most painful symptoms. 
* Op. cit., p. ix. 



ITS SYMPTOMS. 1 75 

Stomach. — Vomiting — first of food, then of a whitish floc- 
culent fluid, violent and constant — of a frothy liquid ; 
inodorous liquid ; greenish watery liquid ; brown slimy mat- 
ter ; white liquid, with painful retching ; yellow liquid ; 
blackish matter along with the water drunk ; dark coffee- 
ground-like liquid ; clear water in great quantities ; dark 
red liquid with sour smell ; bloody liquid twice with coagula ; 
severe pain in the stomach ; roaring furiously from pain in 
the stomach ; soreness on pressure ; burning in the stomach. 

The vomiting in cholera is quite peculiar. It resembles 
the gush which would follow a large slit in a wine-skin full 
of water. It comes away in vast streams, without any effort 
sometimes on the part of the patient. 

Abdomen. — Borborygmus ; pain in epigastrium ; increased 
on pressure ; weight in epigastrium ; severe pain in abdo- 
men ; soreness ; tenderness on pressure ; pain in bowels as if 
grasped by nails ; pain increased by motion ; cramps in the ab- 
dominal muscles ; the muscles raised, hard, arched, as in preg- 
nancy ; during the cramps the muscles feel drawn into knots. 

Fceces. — Constant desire to pass stools ; in gushes when 
vomiting ; in a constant stream ; scalding, watery, inodorous ; 
thin and bilious ; white like gruel ; a colourless fluid, with 
white flakes ; watery, with a grey flocculent cloud ; green 
liquid ; dusky red liquid, with brown and white flocculi. 

On this subject Mr. Scot writes : — 

" The dejections are sometimes made without effort or 
uneasiness ; at others, they are thrown out with great force, 
which has been compared to the squirt of a syringe. They 
also sometimes take place simultaneously with vomiting, 
spasm, and stoppage of the pulse, as if all these affections 
originated, at the instant, from one common cause. There 
is seldom much griping or tenesmus, although the calls are 
very sudden, and are irresistible. Pain on pressure of the 



^;^m^;^?^0^.f^00^ 



Bill 



176 ON EPIDEMIC CHOLERA. 

abdomen is only occasionally noticed. In advanced stages 
of the disease purging generally ceases ; but, in many cases, 
a flow of watery fluid from the rectum takes place on any 
change of position. The matters evacuated, after the first 
emptying of the bowels, have been occasionally observed to 
be greenish or yellowish, turbid, of a frothy appearance like 
yeast, and sometimes bloody. In some cases they are in- 
odorous, in others they have a rank fleshy smell. In one 
fatal case, pure bile, it is said, was discharged. Perhaps 
much of this variety may depend on the previous state of 
the large intestine, especially in Europeans, who so generally 
labour under a morbid condition of that organ ; but by far 
the most common appearance is that of pure serum, so thin 
and colourless, as not to leave a stain on the patient's linen. 
The next in order of frequency is the congee or rice-water- 
like fluid ; the mucus is at times so thoroughly mixed, how- 
ever, with serum, as to give the whole the appearance of 
milk or chyle. The evacuations have also been observed to 
resemble soogee in colour and consistence ; and these cases 
were mild. Worms are very commonly discharged by stool. 
The reappearance of faecal matter, especially if tinged with 
bile, seldom, perhaps never, takes place till the disease has 
been subdued. The quantity of the clear watery fluid, 
which is sometimes discharged, is exceedingly great ; and, 
were it uniform, it might afford us an easy solution of the de- 
bility, thirst, thickness of the blood, and other symptoms ; but 
it is unquestionable that the most fatal and rapid cases are 
by no means those which are distinguished by excessive dis- 
charges. We have innumerable instances, on the contrary, 
of death ensuing after one or two watery stools, without the 
development of any other symptom affecting the natural 
functions. Even collapse has come on before any evacua- 
tion by stool had taken place/' 



ITS SYMPTOMS. 177 

Urine. — Suppression of urine. 

This is one of the most important symptoms of the dis- 
ease. It is rarely absent ; and until it be overcome, although 
all else looks favourable, there is always ground for great 
anxiety. The following case illustrates this well. In it all 
the other symptoms had subsided, and we had every reason 
to expect a favourable termination ; but he died : — 

" Case XVII. — J. H., aged 38. — Intemperate habits. He 
was drinking to .excess yesterday; was seized at 10 last 
night witli vomiting and bowel complaint. We saw him 
first at half-past 7, a.m., 13th November. Watery purging 
through the night, none since 9, a.m. ; urinated about an 
hour ago ; severe cramps in legs, arms, hands, and side ; 
body warm ; feet, hands, and face cold and livid ; pulse 106, 
small, weak, and indistinct ; voice hoarse ; great thirst. 
" Tinct. Camph. every five minutes. 
" 10, a.m. — Cramps in legs very severe ; in other respects 
the same. 

" Verat. 3d dil. and Cupr. 3d dil. alternately every 
quarter of an hour. 
" 4, p.m. — Severe cramps in his legs, and frequent vomit- 
ing ; voice low and hoarse. 

" Continue Verat. 
" 14th, 9, a.m. — Vomiting continues every few minutes ; 
bowel complaint abated ; no urine since yesterday afternoon ; 
great thirst and hiccough ; voice stronger; pulse 76, small. 
" Arson. 3d dil. and Nux vom. 3d dil. 
alternately every half-hour. 
" 10, p.m. — Pulse 100, small ; vomiting continues ; tongue 
covered with white fur, warm ; no pain at epigastrium ; 
slight cramps in the legs continue ; no urine passed. 
" Canthar. 3d dil. every half-hour. 

M 



178 ON EPIDEMIC CHOLERA. 

" 15th, 9, a.m. — Slept well ; no urine passed ; very little 
vomiting. 

" Nux voro. 1st dil. every half-hour. 

" 12 noon. — Vomiting ceased ; frequent ineffectual incli- 
nation to urinate. 

" Digital. 3d dil. every half-hour. 

" 9, p.m.— Still no urine passed ; one abundant bloody stool. 
" Hellebor. 6th dil. every half-hour. 

" 16th, 10, a.m. — No change. 

" 10, p.m. — Still no urine passed. 

" 17th, half-past 8, a.m. — Speaking indistinctly; he com- 
plains of pain in his chest ; it sounds clear on percussion ; 
respirations 30 ; pulse 68 ; tongue dry ; slight strabismus ; 
no urine passed ; no pain or fulness over the pubis ; some 
difficulty in swallowing ; hands cold, shrivelled, livid. 
" Stramon. 9 dil. every quarter of an hour. 

" 3, p.m. — No improvement. 

" Laches. 6th dil. every quarter of a hour. 

" 9, p.m. — He died a few minutes before this visit, on 17th 
November/' 

Larynx. — Voice husky, varies ; at one time clear, at 
another hoarse and indistinct ; feeble and moaning, scarce- 
ly audible ; a hollow whisper. 

The voice in cholera is so peculiar that it has received a 
particular name, called " vox cholerica." Although fre- 
quently present, this is by no means a constant symptom. 

Chest — Breathless ; breathing much oppressed ; gasping ; 
sighing ; spasmodic catching of the breath ; catching pain 
at precordium ; cutting pain at right side, which catches the 
breath ; heaving of the chest ; breath perfectly cold ; very 
fetid ; he rubs his chest with his hand ; complains of op- 
pression of chest; palpitation of the heart; heart's action 



£*$ 



ITS SYMPTOMS. 179 

very feeble ; not perceptible by the hand ; complains of op- 
pression of the heart — says " it is bursting f complains of 
the weight of the bed-clothes — throws them off. 

As we before mentioned, in almost all the severe cases, the 
heart seemed the organ, the disturbance of which most sen- 
sibly affected the patient. Some strange, inexpressible, dis- 
tressing sensation about the heart seemed altogether to over- 
whelm them ; and whenever this was removed, there was an 
expression of extreme relief. We may give a case in illus- 
tration of this : — " A respectable woman was suffering much 
from pain in the limbs and excessive uneasiness at the heart, 
after taking some medicine, she exclaimed, ' God be thanked, 
my heart is getting better/ " 

Trunk covered with warm perspiration, the extremities 
being cold ; cramp in intercostal muscles ; pain in the loins ; 
pain in the right side ; severe pain in the back ; cramp in 
the muscles of the back. 

Arms. — Severe cramps in the arms ; cramp in the wrist ; 
hands livid, cold, and clammy ; skin of the fingers livid and 
corrugated ; nails blue ; fingers crooked, and the whole hand 
distorted during the cramps. 

Legs. — Violent pain in the legs ; violent cramps in the 
thighs and calves of legs ; cramps in feet ; toes drawn down 
by cramps ; feet cold and blue ; quick spasmodic quivering 
motion of the fibres of the muscles of the calf of the leg. 
During the cramps, the muscles feel as if drawn into knots 
or balls ; whole limb livid and cold ; skin of toes shrivelled 
and corrugated ; nails blue. 

The majority of patients partially recover from this state 
of collapse ; although in some instances, especially at the 
commencement of the epidemic, there is no reaction what- 
ever. The following case is a striking example of a person 



180 ON EPIDEMIC CHOLERA. 

struck down by the poison, and dying without an effort, as 
an ox dies from a blow upon the head : — 

" Case X. — Mrs. F., aged 46, went to bed in her usual 
health between nine and ten, p.m., on the 29th of October; felt 
pain in the head and chilly during the night, and especially 
between three and four o'clock the following morning, when 
the bowels, were copiously moved, and she began to vomit 
with each evacuation of the bowels, which occurred every 
eight or ten minutes ; had also cramps in the legs and pain 
at epigastrium. When seen first, a little after six o'clock of 
the same morning, her face was cold and ghastly, and had 
a peculiarly melancholy expression ; she frequently repeated 
the words, ' What is with me ? I cannot live, I cannot live/ 
She was very restless ; the pulse languid and intermittent, 
and the skin ice cold ; she complained of pain in the loins. 
" Secale, 1st diL, every five minutes. 

"After a little time, she was violently cramped in the 
fingers and toes. She then got camphor, repeated at short 
intervals. There was no vomiting for quarter of an hour ; 
pulse became more languid, 76 in a minute, scarcely percept- 
ible ; vomited and purged twice during the next quarter of an 
hour ; very restless ; sighing and panting for want of breath. 
" She then got arsen. 3d dil. 

" Quarter past 7, a.m. — Pulse gone ; cold clammy perspi- 
ration ; vomiting of a pale-white, watery liquid, with gurg- 
ling in the throat. 

" Carbo. veg. 3d trit., alternately with Ipecac. 3d dil. 

" 9, a.m. — Collapse continues. Vomited once, and bowels 
not open ; fits of excessive restlessness, and cramps occa- 
sionally in the fingers and toes. Continue medicine. 

"12 noon. — Much the same; no vomiting or purging; 
great thirst ; flying pains through the body. 



ITS SYMPTOMS. 181 

" Pulsat. 3d dil. 

"3, p.m. — No change. Voice became a whisper. Her 
words were, ' There will never be ease for me in this world/ 

" 8, p.m. — Has been quiet and speechless from 5, p.m. Is 
quite insensible. Bowels twice opened. Died at half-past 
8, p.m., of the 30th/' 

The stage of reaction takes place with more or less rapi- 
dity. The more gradual it is the better. It is not neces- 
sary to give a detail of the symptoms of this stage, for they 
differ only in a few particulars and in degree from the pre- 
ceding stage. There may be reaction to almost any amount, 
from a slight increase of warmth to a complete return of the 
pulse, and yet the patient may not recover. In most of the 
fatal cases, there was partial reaction ; and till we became 
conversant with the turns of the disease, we were sadly dis- 
appointed to find, after an apparent approach to recovery, a 
sudden and almost instantaneous sinking of all the vital 
powers. We may give a case in illustration, in which the 
pulse reappeared, vomiting and purging ceased, cramps 
diminished, and the patient was bathed in warm perspira- 
tion, and yet died a few hours after all these favourable 
symptoms : — 

" Case VI. — R. A., aged 30, a man of intemperate habits, 
who had been drinking whisky the previous day, but other- 
wise in his usual health. He was seized with vomiting and 
purging and cramps about midnight of the 24th of October; 
and when seen at 5 o'clock the next morning, he was found 
standing on the floor roaring with pain. His face was pale 
and anxious ; his lips and breath were quite cold ; no pulse 
could be felt, and he could not move from where he stood 
from the violence of the cramps. Alvine evacuations watery, 
what he vomited was tinged with blood. 



182 ON EPIDEMIC CHOLERA. 

" Camphor to smell, and afterwards arsenicum, 3d dil., 
frequently repeated. 

"Half-past 8, a.m. — Profuse warm perspiration over the 
whole body ; no vomiting or purging ; slight cramps ; urine 
suppressed ; great thirst ; pulse barely perceptible. 

" 11, a.m. — Countenance cadaverous; very breathless; 
moaning from pain. Sunk and died at half-past 1, p.m., 
twenty-five hours ill, and twenty hours under treatment/' 

It only remains for us now to describe the symptoms of the 
consecutive fever into which patients sometimes fall after 
coming out of the other stages of the disease. We have 
had but little experience in this form of the disease, as there 
were only four cases of consecutive fever, out of 236 cases of 
cholera, treated homoeopathically ; whereas, out of 230 cases 
treated at the Cholera Hospital, there were 39 fatal ones 
from this cause. Two out of our four cases recovered. So 
that out of 236 cases we had two deaths from the consecutive 
fever ; and in the hospital there were, out of nearly the same 
number of patients, 39 deaths. We advert to this here in 
passing, and shall reserve a fuller comparison of the results 
of treatment for the next Chapter. 

SYMPTOMS OF THE CONSECUTIVE FEVER. 

General symptoms. — Uneasiness, restlessness, hiccough, 
stupor, insensibility. 

Skin. — Hot and dry, or hot and moist. 

Sleep. — Drowsy ; ineffectual desire to sleep ; starts in her 
sleep. 

Fever. — Pulse slow and weak, and full. 

Moral symptoms. — Insensibility, delirium ; low mutter- 
ing delirium. 

Head. — Pain in the head ; noise in the head. 



ITS SYMPTOMS. 183 

Eyes. — Eyes inflamed ; conjunctiva of lower half of eyeball 
injected ; strabismus, blindness. 

Ears. — Deafness. 

Face. — Sunken ; twitching of the muscles of the face. 

Teeth. — Grinding of the teeth ; teeth covered with black 
sordes. 

Mouth. — Tongue dark and brown, dry and glazed, dry and 
bleeding ; speech indistinct ; speechless. 

Throat. — Burning in the throat ; dry and painful when 
swallowing ; sensation of choking ; inability to swallow. 

Appetite. — Great thirst. 

Stomach. — Occasional vomiting of greenish liquid; burning 
pain at epigastrium. 

Fwces. — Dark-brown liquid. 

Urine. — Suppression of urine ; very scanty; passed with 
pain. 

Chest. — Breathing much oppressed ; gasping ; sighing. 

Trunk , Arms, and Legs. — Pain and uneasiness ; occasional 
slight cramp in legs. 

We have not in this enumeration entered all the symptoms 
common to the fourth stage and the two preceding ones ; 
but we believe, that after the perusal of the following case, 
which was very carefully observed, the reader will have no 
difficulty in forming a tolerably accurate picture of this fatal 
disease : — 

" Case XV. — B. S., a healthy-looking young woman of 21 
years of age, living in a comfortable room, had been quite well 
till 2 o'clock, p.m., of the 2d November, when she became 
affected with nausea, for which she got some Allopathic drugs, 
after taking which she began to vomit. She was seen at half- 
past 11 o'clock, a.m., of the 3d; had been vomiting clear 
water, and passing watery stools, all the previous night. The 
surface was cold ; the pulse 120, feeble ; the tongue red with 



184 ON EPIDEMIC CHOLERA. 

frothy margin, and warm ; there was slight pain at epigas- 
trium on pressure ; no pain anywhere else ; felt giddy when 
she rose. 

" Secale, 3d dil., a dose every quarter of an hour. 
" Half-past 2, p.m. — No better ; violent vomiting of dingy 
fluid ; cold arms and hands ; pulse feebler. Had passed 
little urine the previous night. 

" Arsen. 3d and Verat. 3d, 
a dose every quarter of an hour alternately. 
" Half-past 3, p.m. — Pulse scarcely perceptible ; much 
vomiting ; lips and nose cold, breath warm ; complained of 
the urine being scalding. 

" Cantharid. 3d dil. and Arsen. alternately. 
" 5, p.m. — Vomited twice and purged once since last re- 
port. Pulse 120 to 132, feeble. 

" Ipecac. 1st dil., followed by former medicines. 
"Half-past 7. — Vomited and purged twice; pulse 120; 
face bluish, cold ; tongue cold ; no cramps ; much pain in 
epigastrium. 

" Arsen. 3d, every quarter of an hour. 
"Quarter past 9, p.m. — She had taken cold tea, followed 
by vomiting, which had continued ever since. 
" A dose of Ipecac. 1st dil., 
followed by Arsen. 3d and Canth. 3d alternately. 
" Quarter to 12, p.m. — No vomiting since last report. 
Purged once ; catching pain in the precordial region when 
she breathes deeply ; very thirsty, the more she drinks, the 
worse is the thirst. 

" Cuprum, 6th, one dose, and Arsen. and Canth. as before. 

" Nov. 4th, quarter past 7, a.m. — Had cramps about 3 

o'clock in the morning in the calves of the legs and wrists ; 

vomited three times and purged twice ; so thirsty that she 

drank all the water in the bottle applied to her feet ; pulse 



ITS SYMPTOMS. 185 

112, weak. She looks better, and the voice is stronger; 
occasional cramps in the wrist. 

" Cuprum, 6th, one dose, 
afterwards Arsen. and Veratr. alternately. 
" Half-past 9, a.m. — Pulse 100 ; tongue and skin warmer ; 
stools darker, more fseculent ; great thirst. 

" Continue Arsen. and Veratr. 
" 3, p.m. — Pulse 108 ; vomited three times a green watery 
fluid ; bowels twice moved ; complains of burning in the 
throat ; no urine. 

" Canth. 3d and Arsen. 3d alternately. 
" 8, p.m. — One copious brown stool ; pulse 90, wiry ; great 
thirst ; cramp in the leg. 

" One dose of Cupr. Acct. 3d, 
and afterwards Arsen. and Veratr. every half-hour. 
" Nov. 5th, 10, A.m. — Much better ; skin and breath and 
tongue warm ; slept several times for a short time ; has had 
much ineffectual desire to make water. 

" Canth. 3d and Arsen. 3d, alternately every half-hour. 
"11, a.m. — Pulse 88, stronger; purging a little brown 
water; less thirst. 

" Arsen. 3d, half-hourly. 
" Nov. 6th, 1, a.m. — Sound asleep, quite warm, and pulse 
natural. Continue medicine. 

" Half-past 11, a.m. — Bowels were moved two or three 
times, and the evacuations were reported to be dark. The 
tongue is dark-brown ; pulse 88, strong. Complains of much 
general uneasiness ; no urine has been passed. Ordered a 
little arrow-root. 

" Tereb. 3d dil. hourly. 
" Half- past 11, p.m. — The tongue is dry and red; pulse 
88 ; great general pain complained of; bowels once moved ; 
inflammation of the eye. 



186 ON EPIDEMIC CHOLERA. 

" Continue Tereb. 
" Nov. 7th, half-past 9, p.m. — Bowels only once moved to- 
day, the evacuation dark and thin ; some urine passed ; face 
flushed ; tongue red ; breathing oppressed. She had got 
up and gone into the kitchen, along a stone floor, and had 
eaten a part of an apple. 

" Bellad. 3d dil, a dose every hour. 
" 8th, half-past 9, p.m. — Little change ; had passed urine 
three times. 

" Arsen. 3d and Bell. 3d alternately, hourly. 
" Nov. 9th, noon. — Very delirious ; blood coming from the 
mouth ; tongue red ; great thirst ; pulse jerking, feeble, 
about 80. 

" Continue Bellad. 3d dil. 
" 7, p.m. — Much tossing ; tongue and lips dry and bleed- 
ing ; eyes staring ; hands cold ; pulse slow. 
" Arsen. 3d dil. 
" 9, p.m. — Laborious breathing ; bluish, speechless ; pulse 
75 ; seems insensible. 
" Laches. 6th and Arsen. 3d alternately, every half-hour. 
" 10th, 8, a.m. — Hands and arms cold ; breathing labo- 
rious ; lips and teeth covered w T ith black sordes ; passed a 
very restless night ; no purging or vomiting ; cannot speak, 
but is sensible when spoken to. 

" Bell. 3d dil. 
" She died at 6, a.m., of the following morning/' 



ON EPIDEMIC CHOLERA. 187 



CHAPTER V. 

ITS TREATMENT. 

We have no sympathy with the philosophical scepticism 
and the elegant dilettantism which is now becoming fashion- 
able in the medical profession. We can perfectly under- 
stand a Dr. Sangrado confiding in his lancet and his hot 
water ; or a Dr. Slop astonished how it was possible that any 
children came into the world before the invention of his 
crotchet ; but we cannot understand how clear-sighted and 
conscientious men can practise medicine, and avow their dis- 
trust of the means they use. The late accomplished editor 
of the British and Foreign Medical Review has set such an 
unblushing example of a profession of no faith in physic, 
which he nevertheless continues to prescribe, that we may 
look upon him as the best specimen of a numerous and fast 
increasing class, if not as actually the head of a school, which 
he denominates " young physic/' but which he ought to have 
called the no-physic school. Among the reasons of his un- 
belief, we have the following : — 

" Lastly, we must advert to what is, perhaps, the most 
extensive and valuable source of all — the actual practice of 
the more scientific physicians of all ages, in the latter part 
of their career, — men of philosophic minds as well as of much 
experience. It is well known, from the history of physic, 
that a large proportion of men of this class have, in their old 
age, abandoned much of the energetic and perturbing medi- 



188 ON EPIDEMIC CHOLERA. 

cation of their early practice, and trusted greatly to the re- 
medial powers of nature. The saying of a highly respected 
and very learned physician of Edinburgh, still living at an 
advanced age, very happily illustrates this point. On some 
one boasting before him of the marvellous cures wrought by 
the small doses of the Homoeopath ists, he said, ' this was no 
peculiar cause for boasting, as he himself had, for the last 
two years, been curing his patients with even less, viz., with 
nothing at all ! ' " 

The effect of this doctrine upon the profession must be 
most disastrous. Without a strong faith there can be no 
strong action. But not only can there be no hearty trust 
in the measures they employ, but there must be a continual 
dissimulation. If they make it known that they intend 
giving no medicine, will patients go to them for medicine ? 
Surely not. They will be obliged either to have no patients 
then, or to pretend to give physic when they are giving no- 
thing. Is this position tolerable for an honest man ? We be- 
lieve that in no profession, not even in the Church, is a high 
morality so essential as it is in the delicate confidential in- 
tercourse between a physician and his patient. And if a 
patient comes to know that his physician has been systema- 
tically deceiving him, will that knowledge not first degrade 
the profession in the eyes of the public, and in so far as that 
profession ramifies through all the branches of social life, will 
it not, instead of elevating the standard of public morality 
and protesting against the prevailing insincerity of the age, 
be the most contaminating of all the evil influences which 
are fast corrupting our whole social frame ? It may seem 
absurd to find any connexion between Red Republicanism and 
Young Physic. But we believe that the flag of terror which 
is now waving over all Europe is the necessary result of a 
system of deceit, and that every one who advocates or prac- 



ITS TREATMENT. 189 

tises hypocrisy, is doing, in his own sphere, what he can to 
prepare the soil of our land for those " trees of liberty" which 
men plant upon the grave of freedom, and that righteous- 
ness by which a nation is established. 

These reflections w r ere forced upon us by the easy, self- 
complacent tone of the organs of the medical profession in 
regard to the various means of treating the fatal epidemic 
which is even now at our door. 

A writer on the subject in the Medical Gazette, for Octo- 
ber 15, 1847, observes : — " The Homceopathists have boasted 
of their success in treating cholera ; the secret of this is, 
that they did not interfere so much as regular practitioners, 
and gave full play to the vis medicatrioo naturce." This 
seems an acknowledgment, that it would be better for the 
thousands who are likely to take cholera to have no " regu- 
lar" physicians allowed to meddle with them. 

We are hardly disposed to go so far as our opponent in his 
admissions against himself ; but there is one thing which cer- 
tainly rather confirms his view of the case, and it is this, 
that under the most opposite methods of Allopathic treat- 
ment, and in the most varied circumstances, the mortality, 
both in this and the previous epidemic, has been nearly 
exactly the same. We may quote again from Mr. Scot's 
book : — 

" It seems unnecessary to pursue this part of the subject 
farther : it is manifest that, after the lapse of about thirty 
years, no material change has been made in the treatment 
of cholera. Not that new remedies and new plans of treat- 
ment have not been abundantly proposed — many of them 
of the most opposite nature — but that, after trial, almost all 
have been abandoned ; and we now r find professional men 
constantly and silently recurring to the old routine, if we 
may so designate it. But the most surprising, the most 



190 ON EPIDEMIC CHOLERA. 

melancholy, and the most mortifying thing of all is, that, 
under every method of treatment hitherto pursued, in any 
quarter of the world, the average rate of mortality of cholera 
continues much the same — certainly not diminished, perhaps 
rather augmented. We possess no means of judging cor- 
rectly of the relative mortality from cholera, as it may be 
affected by climate. To attain that object, we should have 
returns of the cases of cholera occurring amongst the natives 
of India of all classes, in several districts, towns, or villages, 
to contrast with similar returns in Europe. The chief diffi- 
culty, however, in India, would be the incorrectness of such 
returns, not much dependence being placed on the judgment 
or fidelity of the native doctors, or the native revenue ser- 
vants, usually employed on that duty. The only return of 
this description which seems entitled to consideration, relates 
to an extensive district to the northward of Madras. It ex- 
hibits an aggregate of 14,723 cases, yielding 4345 deaths, 
scarcely 30 per cent. In some villages, the mortality rose 
to 89 in 100, 10 in 13, 48 in 70, 99 in 143, when there was 
either no medical aid, or when it was refused. In the prin- 
cipal town, where the European medical officer resided, and 
where classification would be more correct, the rate was 40 
per cent. The returns in this country, at present published 
by the Board of Health, are generally said to be incorrect, 
and not to exhibit the numbers actually seized with cholera. 
If, however, they give a true account of the events of the 
cases entered, it is sufficient for our present purpose. Now, 
up to 22d February, these returns give 12,621 cases, 5595 
deaths, 3840 recoveries, and 3186 remainders, which exhi- 
bits a ratio of mortality of only 44 per cent. ; but, taking 
this per centage of 44 out of the remainders, 3186, it yields 
1400 to be added to the deaths, and the real rate of morta- 
lity will be found to be at least 55 per cent." 



ITS TREATMENT. 191 

In Russia, from the 16th of October 1846, to the 23d of 
June 1848, the number of persons attacked by cholera was 
200,318, and out of these 116,658 died, giving a mortality 
of 57 per cent.* 

According to Lase-gne, there is little difference in the mor- 
tality in the former and recent epidemic. In Moscow, on 
the former occasion, the number of cases was 4461, the 
deaths 2425, giving a mortality of about 54 per cent. ; so 
that we may safely state, that invariably under Allopathic 
treatment, the mortality exceeds 50 per cent. 

If we find that under Homoeopathic treatment the morta- 
lity is invariably less, we think we may be excused entering 
into any detail of the various remedies used by the old 
school ; for even with our better medication, the mortality is 
very great, and we are but little disposed to encounter the 
certainty of a great increase in the number of deaths. We 
propose then adducing proof of the lesser mortality of cholera 
under Homoeopathic than under Allopathic treatment, and in 
doing so we shall only take a small portion of evidence, but 
shall try to sift it well, so that it may be thoroughly relied 
on; and we shall call no witnesses but those for whose integ- 
rity we can vouch, or who can be shown to be worthy of credit 
by the expressed opinions of their opponents. 

Although we have stated the general mortality of the 
cholera in the last and present epidemic at about 55 per 
cent., the number of deaths in hospitals was much greater. 
In the Cholera Hospital of Edinburgh during the present 
epidemic, out of 230 admitted, 149 died, and only 68 re- 
covered ; which in round numbers may be stated thus — that 
two out of three die, and one out of three recovers.f* 

In Dr. Lichtenstadt's Cholera Hospital in Petersburgh, 

* Miiller, op. cit. 

f Monthly Journal, January 1849, p. 456. 



192 ON EPIDEMIC CHOLERA. 

during the last epidemic, out of 636 cases, there were 31 7 
deaths.* Dr. Dudgeon, in his able and interesting pamphlet 
on the subject, calculates the mortality at 57 per cent, in 
the Allopathic hospitals. We are disposed to think that he 
has rather under-estimated it. According to Mr. Wilde, 
the present editor of the Dublin Medical Review, whose ac- 
quirements in all departments of knowledge bring back the 
idea of a bygone time when the physician was a man of 
universal accomplishment, states in his work on Austria, 
that the mortality in the general hospitals in Vienna of the 
cholera, during its prevalence in 1831-32, was two-thirds of 
those attacked.-f* 

Dr. Miiller,J speaking of the present epidemic, estimates 
the mortality at two-thirds of all the cases ; so that in com- 
paring the results of the treatment of cholera in Vienna 
under the two systems, we need not hesitate to accept of 
Mr. Wilde's statement as true in the main, — that is, out of 
all the patients in the Allopathic hospitals treated for 
cholera, two-thirds died, and only one-third recovered ; or, 
out of 1000 taken into the hospital, above 700 were carried 
out dead, never again to see the face of their friends. The 
number of families suddenly left destitute by this mortality 
is worth considering ; for when we see figures representing 
the amount of deaths, we are apt to forget that almost each 
unit stands for a little cluster of human beings who are more 
or less affected by its extinction. 

The Homoeopathic Hospital was conducted by Dr. Fleisch- 
mann, of whom Dr. Forbes (who might be called the Peel of 
Old Physic — for a more complete surrender of a party was 
never effected than was done in his memorable article, in- 

* Dudgeon's Treatise on Asiatic Cholera, p. 24. 

f Austria, its Literary, Scientific, and Medical Institutions, by W. R. Wilde, 
M.R.S.A. Dublin, 1843. 
X Op. cit. 



ITS TREATMENT. 193 

titled, " Homoeopathy, Allopathy, and Young Physic/' in 
the British and Foreign Medical Review) thus writes : — "Dr. 
Fleischmann is a regular, well-educated physician, as ca- 
pable of forming a true diagnosis as other practitioners ; 
and he is considered by those who know him as a man of 
honour and respectability, and incapable of attesting a false- 
hood/' He says : — 

" For many years, the ordonnances against Homoeopathy, 
with all their oppressive accompaniments, weighed heavily 
upon us ; and although, in the course of such a length of 
time, now and then something was effected in our favour, yet, 
as this was never done by medical men, little impression was 
produced, and no results. The cholera, which tended some- 
what to lessen the reputation of the medical world, was the 
means of granting medical liberty. I received from Govern- 
ment a charge to tender a report upon the cholera, and the 
best mode of treatment, (in this epidemic, I for the first time 
used purely and solely Homoeopathic remedies, although the 
Proto-medicus* came, in the commencement, daily,) and to re- 
late my experience on the subject. I made a report, (the 
essential points of which I shall briefly state,) at the same 
time I requested an audience, which was granted me by his 
Excellency Count von Kolowrat, when I presented him with 
a copy of the report, at the same time requesting him to 
take Homoeopathy under his protection. His Excellency, a 
man of the most philanthropic disposition, whose constant 
endeavour it is to advance and countenance all that is good 
and valuable, acceded to my request, and a fortnight after- 
wards, it pleased his Majesty to issue an edict revoking the 
former prohibition of Homoeopathy, demanding, at the same 
time, proposals from the Homoeopathic practitioners for put- 
ting a check on charlatans, (had a check long since been 

* The Government Medical Inspector. 

K 



194 ON EPIDEMIC CHOLERA. 

put on charlatans — by whom I don't mean those alone who 
have no diploma in their pocket — of whom Dante says — 

' Questa e la vipera, volta nel ventre della madre,' 

a great opprobrium would have been eradicated from our 
profession,) and so regulating the dispensing business as not 
to interfere with existing laws. The proposals were made, 
and the result we are now looking forward to. 

" The Report. — The first table shows the number of those 
affected, cured, and who died in each police district;* in the 
second is seen what sex and age (at least, among 732 indi- 
viduals) were most subject to its ravages, and, at the same 
time, where and at what time the mortality was greatest. 

* We have omitted this table as being irrelevant. 



ITS TREATMENT. 



195 



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196 ON EPIDEMIC CHOLEBA. 

" As regards the treatment of these 732 patients, I dif- 
fered from the general practice, with the exception of a few 
cases which I shall afterwards allude to,* and, as the result 
shows, I had no reason to repent so doing. I did so, not 
from any blind zeal for a system, concerning whose truth or 
falsity a bitter contest is going on — I was influenced by no 
private interest, for I had previously refused to accept the 
salary awarded me by the Government for my services ; but 
when I called to mind the diverse modes of treatment adopted 
by innumerable physicians in all countries, as far as I could 
ascertain these from their wTitings, I could not but look at 
my position with anxiety ; I could see no inducement to 
tread in the ordinary well-beaten path ; my duty, my con- 
science, urged me to try some other methods. Strifes about 
a theory — which could not be of such importance in this 
case — I wished to leave to the arena of the schools, and em- 
ploy only the practically useful, to the efficacy of which 
many had borne witness, and which had been tested also by 
myself in other diseased conditions, that so I might learn 
what inducements the new way held out, the old one being 
so unpromising. 

" On looking back to the results of this treatment, (and 
the value of any mode of treatment is to be judged of from 
its results on a large scale, since we have no other method 
of forming a judgment,) on considering that more than one- 
half of my patients were from a district (Wieden) where the 
epidemic in 1831 and 1832 had been most severe, and had 
had most victims, where this year it had raged for the 
longest period, that this circumstance was not a little dis- 

* « I treated four patients with calom. and jalap ; two with acid. nitr. fum. ; 
four with sp. sal. amnion, caust. ; six with muriate of soda, but all these died : 
of forty convalescents, where the practice of both schools indicated the same 
remedy, I gave it in Allopathic doses, yet without obtaining any result." 



ITS TREATMENT. 197 

advantageous to the success of the trial, as many were re- 
ceived who had already been dosed with violently acting 
medicines and spirituous domestic remedies, and thus were 
rendered comparatively insusceptible to the influence of my 
small doses, I cannot refrain from stating as my inward 
conviction, that the Homoeopathic is the best mode of treat- 
ment of the cholera, until at least reflection, experience, or 
accident suggest a better method/' 

We perceive from this table that out of 732 persons ad- 
mitted, 488 were restored to their friends, and 244 were 
carried out dead. Suppose that these 732 had been taken 
to an Allopathic hospital, what would have been their fate ? 
We have every reason to believe, that of the 488 whom we 
find returning to their homes, one-half would have been left 
behind among the dead. We cannot wonder at the Austrian 
Government, although about the most bigoted in Europe, 
shrinking from the responsibility of prohibiting a mode of 
practice which proved itself to be so much more successful in 
the dreadful plague which was as destructive to its subjects 
then, as Kossuth and Bern seem to be to its soldiers now. 

The only other hospitals that we know of, in which Ho- 
moeopathic treatment was employed during the former epi- 
demic, were one at Berlin under Drs. Heynel and Stuler, and 
one at Bourdeaux under Dr. Mabit. In the former out of 
32 cases there were 6 deaths, and in the latter, the same 
number of deaths out of 31 cases. We mention this for its 
historic interest, as the numbers are too small to afford data 
for any calculation ; so far as they go, however, they con- 
firm the results of the Vienna hospital. 

In the present epidemic the only notice we have of the 
results of Homoeopathic treatment is in Dr. Miiller's Report 
regarding the cholera in Petersburgh. He says, " The re- 
sults of Homoeopathy have on the whole here not been un- 
fortunate, and on that account it has been partially imitated 



198 ON EPIDEMIC CHOLEKA. 

by other practitioners. In the Homoeopathic hospital, whose 
lists I have myself carefully examined, there have died 
hitherto three-eighths of the patients, among whom, however, 
the milder cases are included." 

In adverting to this, a writer in the British and Foreign 
Medico-Chirurgical Review, the periodical that has succeed- 
ed the one we formerly spoke of, as having been conducted 
by Dr. Forbes, and which died of " Young Physic/' after 
omitting to mention the fact of Homoeopathic treatment 
having so commended itself to the profession in Petersburgh 
as to be partially imitated, says, " We do not think the 
Homoeopathists have much reason to congratulate them- 
selves on their success. If the choleroid cases are included 
in the lists, the mortality of 37 per cent, is very high. We 
suspect that their success was about commensurate with 
the philosophy of their creed, and with the general truth of 
their statements, in neither of which do we put the slightest 
faith/' Let us observe that the only source of this writer's 
information is the paragraph we have quoted at full length 
from Miiller's Report, a work impossible to be obtained in 
this country, and which we had to get from Germany ; that 
in his report the word choleroid cases does not occur — that 
he evidently believed the results of Homoeopathic treatment 
to be successful — that the other physicians of the place be- 
lieved them to be so successful that they w r ere led to imitate 
them in the means they employed — that there is not a word 
to make us believe that the cases were not true cholera 
cases — some severe and some slight, as are met with in all 
hospitals : let all these facts be kept in mind, and then let us 
decide whether the Austrian Government, (if there be one,) 
or the medical profession of this country, be on the whole 
the most liberal. We do not so much blame the poor author 
of this paragraph ; unfortunately in the present state of 
things, people must write to please their readers, (sad degra- 



ITS TREATMENT. 199 

elation !) and if they dare to tell them unpalatable truths, 
they are immediately forced either to retire or to retract. 
Dr. Forbes, the former editor said, he believed Homoeopathic 
physicians to be capable of recognising disease and incapable 
of direct falsehood. Dr. Forbes was too liberal, he therefore 
retired, and in his place we have this writer, who says, he 
does not put the slightest faith in the statements of Homceo- 
pathists. Alas, for a profession which silences those who speak 
the truth, and rewards those who conceal and pervert it ! 

It is much more difficult to obtain important data from 
private and dispensary practice than from the results in 
hospitals. There is such a variety in the cases called cholera. 
However, there is one remarkable coincidence about the few 
Homoeopathic practitioners whose own testimony we have 
examined, and that is, that the mortality in their hands seems 
to have borne a pretty accurate proportion to the average 
Allopathic mortality, rising and falling with it, but always 
keeping much lower through all its fluctuations. 

Dr. Hummel, who is thoroughly to be depended upon, 
states, in a paper read before the Homoeopathic Assembly 
at Cothen, in August 1832, that the comparative results of 
his treatment, and that of his Allopathic brethren, were as 
follows : — 





Cases. 


Cured. 


Died. 


Remaining. 


Under Allopathic treatment, 


164 


47 


101 


16 


Under Homoeopathic treatment, 


46 


28 


16 


2 



This gives a mortality of about 1 in 3 for the Homoeo- 
pathic, and 2 in 3 for the Allopathic. The disease seems to 
have been very malignant at Merseburg when Dr. Rummel 
treated it, and he seems carefully to have excluded from his 
list all equivocal cases.* 

When 'the cholera appeared in Moravia, Dr. Gerstel, who 
had already treated it Homceopathically, was sent thither, and 
Archiv. fur die Horn., vol. xiii. 



200 ON EPIDEMIC CHOLERA. 

the following testimonial was given him by the Government 
district-physician, Dr. von Merk : — " As regards the dura- 
tion of the prevailing epidemic, this was in some districts 
extremely short, and the course rapid and severe ; the result, 
owing to the judicious treatment, generally favourable ; hence 
the proportion of deaths compared to other places where the 
epidemic raged was small. The Homoeopathic treatment, 
which was carried out here to a great extent by Dr. Gerstel, 
was the cause of the favourable result/'* 

Our countryman, Dr. Quin, being then on the Continent, 
and acquainted with Homoeopathy, having heard of the se- 
verity of the disease in Moravia, and how Dr. Gerstel was 
engaging it single-handed, with the gallantry of a crusader, 
started to join him, and oppose the rapidly advancing foe. 
His life had nearly paid the forfeit of his devotion. He was 
seized with cholera, but rapidly restored, and was enabled to 
be of great service to the sick. The chief magistrate of the 
town, one Ernest Dieble — a sort of Lord Provost (very un- 
like ours, as will be seen by and bye) — by the desire of the 
Council, sent him a letter of thanks, couched in very flat- 
tering terms, and what is of more consequence, a certified 
list of the number of deaths under the various modes of 
treatment. From; this we learn that the number of in- 
habitants was 667 L ; that from the 7th November 1831, to 
the 5th February 1832, 680 were attacked, and of these 
540 recovered, and 140 died. The deaths and recoveries 
being thus distributed : — 





Affected. 


Cured. 


Died. 


Treated Allopathically, 


331 


229 


102 


Treated Homoeopathically, 


278 


251 


27 


Treated by camphor alone, 


71 


60 


11 



This gives a mortality of about 33 per cent, to'the Allo- 
pathic physicians, 10 per cent, to the Homoeopathic physi- 
* Dudgeon's Pamphlet on Cholera. 



ITS TREATMENT. 201 

cians, and 15 per cent, to the remedy which we suppose was 
given without any medical attendant, but which is Homoeo- 
pathic to the first stage of the disease. The facts we here 
state rest on as good authority as any historical statements 
can ; and if any one contemptuously rejects them, he must 
be prepared to give up all faith in history. 

We now come to our own results in Edinburgh ; and we 
may observe at the outset, that the trustworthiness of these 
results rests solely upon our own authority and that of our 
colleagues, one of whom, Dr. Sutherland, formerly of the 
H.E.I. C.S., was quite familiar with the disease, having had 
to treat it frequently in India. We cannot produce any 
official testimonial, for, as will be more particularly stated 
afterwards, we reported our cases, by the advice of Dr. 
Sutherland of the Board of Health, direct to London, to 
avoid the impertinent interference with our patients by those 
who came under the guise of inspectors, and made observa- 
tions, and even used threats to induce j)ersons whom we were 
treating to give up the Homoeopathic medicine. We repeat, 
therefore, that if our authority for the statements we are 
about to make be not sufficient, we must be content with the 
ample evidence already adduced. 

Hitherto we have left out of consideration altogether, in 
comparing the results of the two systems, the length of time 
required by each to effect a cure. We have no accurate data 
by which to ascertain the average duration of Allopathic 
treatment. Miiller says, (p. 28,) " A cure was seldom effected 
rapidly in a few days ; this happened in about one-eighth of 
the patients, and then it was confined to the slight cases,* 

* This proves that there were slight cases treated in the general Allopathic 
hospitals, as^well as in the Homoeopathic. Is it not strange that the reviewer 
we before alluded to should have reserved the word "choleroid" exclusively 
for the Homoeopathic hospital cases, although in the original, the term applied 
to both is precisely the same? 



202 ON EPIDEMIC CHOLERA. 

and those early treated. Yet there are examples of even 
severe cases having been dismissed cured in three or four 
days. In general, the recovery took from ten to sixteen 
days to complete." 

The following table shows the mortality in the cases 
treated by us, and the average duration of the cases, includ- 
ing typhoid ones : — 

Average time. 
Cases. Recoveries. Deaths. Mortality. Recoveries. Deaths. 

Days. Hours. 

236 179 57 24/ 5 3 56 

These cases occurred between the 4th October and the 
1st of February. During the same period in Edinburgh, 
among patients of precisely the same class, and in exactly 
similar situation and circumstances, there occurred under 
Allopathic treatment — 



Recoveries. Deaths. 

876 271 546 

which gives a mortality of 62 per cent. That is, if a 
thousand persons had been attacked, 620 would have died 
under the ordinary treatment, and only 380 recovered ! A 
frightful mortality ! While, if a thousand had been treated 
according to the Homoeopathic system, 240 would have died, 
and 760 would have recovered. Still a great mortality. 

In making our calculations, we have used the tables fur- 
nished to us by the Secretary of the Board of Health, and 
in the next Chapter they will be found at full length. 

We think we may now consider the hypothetical position 
we started with as established beyond a doubt, that in 
various countries, in this epidemic the result has uniformly 
been more favourable under Homoeopathic than under Allo- 
pathic treatment, and we shall therefore pass at once to a con- 
sideration of the measures employed by Homoeopathic practi- 



ITS TREATMENT. 203 

tioners to obtain these results. Before going into a minute 
criticism of the individual remedies, we shall state the general 
measures which we have found of service in treating patients 
aifected with cholera, and then describe the medicines proper 
to be used in each of the stages of the disease. 

Beyond the administration of the specific medicine, the first 
stage requires no peculiar management, except that quiet and 
abstinence be strictly enjoined. In the second stage, however, 
it is advisable to adopt auxiliary measures to aid the struggle 
of the restorative powers of the system. The object of treat- 
ment is to induce a slow, steady reaction. Let this be borne 
in mind. Too rapid a reaction is dangerous, and frequently 
terminates the patient's life suddenly, or induces the con- 
secutive fever. From experience, we should recommend the 
following steps : let there be a general warmth in the apart- 
ment, by means of a fire, if the weather be cold ; let the patient 
be covered with two or thre'e blankets, not more ; let bottles 
of hot water be put at his feet and sides, if the body is 
cold ; if there are cramps, gentle and continual stroking of 
the affected parts gives relief ; the intense thirst must be 
allayed by frequent moderate draughts of cold water. In 
some cases we tried large draughts of hot water, but we can- 
not report very favourably on the result. There is no objec- 
tion to their trial, however. They were recommended as 
conducing to supply the want of animal heat. Neither can 
we recommend embrocations of any kind, whether camphor 
or turpentine. It is very doubtful if they do any good, and 
they probably interfere with the action of the medicines. 
Another thing of great importance to attend to is, that the 
patient abstain from all food. Not unfrequently, when the 
reaction sets in, there is a craving appetite ; and as every- 
thing seems going on favourably, the physician is apt to in- 
dulge the patient's desire for something to eat. In repeated 



204 ON EPIDEMIC CHOLERA. 

instances we have seen sudden relapse follow upon eating ; 
and, in our opinion, it is of the greatest consequence to give 
no food at all, nothing but cold water till the second and third 
stages of the disease be past. They seldom last above forty- 
eight hours, and the patient runs no risk from being kept 
upon a water diet for that time ; and after the recovery has 
begun, the most extreme care is necessary in diet. Nothing 
but arrow-root, sago, very well boiled rice, and such like 
things — and even these in very small quantities — ought to 
be given. A person affected with cholera requires unre- 
mitting attention till he is convalescent. He should be 
seen every few hours, and the most rigid cleanliness of bed 
and person enforced, when possible. There is no disease 
that exacts so much care ; and even if this care fail to pro- 
long life, at all events it mitigates the sufferings of the most 
painful and terrible death. Let it be remembered that the 
invasion is very sudden, and the course of the disease is 
frightfully rapid, and that unless the physician is prepared 
at once as to the treatment he is to adopt, he will only be- 
wilder the agitated family into which he enters. He must 
make up his mind to find all remedies fail, and to be pre- 
pared to assist in making the approach of death less afflict- 
ing than it would be without him ; and let him remember, 
that throughout the whole transition from the flush of vigor- 
ous life to its cold termination, the patient's mind will be as 
clear and calm as it was in health. Everything he does 
and says will be observed, and have its influence. 

Beyond the general directions we have given, there is 
nothing we can add, except that much depends upon the 
presence of mind and good sense of the individual practi- 
tioner. Each case has its peculiar features, and requires a 
management of its own ; and the most experienced and self- 
possessed will often find himself embarrassed, and all his 



ITS TREATMENT— CAMPHOR. 205 

efforts paralyzed by some unforeseen and untoward occur- 
rence. 

The remedy for the first stage of cholera is Camphor. 
This was discovered by Hahnemann ; and in the future 
annals of science it will be mentioned as one of its brightest 
achievements. It is a triumph over the subtlest force of 
matter by the still subtler power of mind ; and it seems 
to have required that clear insight into the essential rela- 
tion of things, by the possession of which the man of 
genius is distinguished from the man of industry and talent 
alone.* 

As soon as the cholera invaded Europe, the Homoeo- 
pathic practitioners began to prepare their weapons for the 
dread encounter ; and the medicines they recommended and 
used have all proved useful in the disease. But they groped 
about in vain for the remedy for the first stage. In the 
volume of the " Archiv. fur die Homceopathie/' for 1831, 
there is a very able paper by Dr. Preu of Nuremberg, prov- 
ing how closely the symptoms of arsenic and veratrum re- 
semble those of cholera, and recommending their adminis- 
tration in the disease. Dr. Schubert of Leipzig in addition 
recommended ipecacuanha and chamomilla. All of these are 
good in certain stages, but as yet no one had hit upon the 
true specific. At this time, as we have seen, the cholera 
was sweeping over Germany, and the believers in Homoeo- 
pathy all looked to Hahnemann, like the inhabitants of 
Syracuse to Archimedes, for some definite instructions. Nor 



* In Mr. Carlyle's fascinating work, " Hero Worship," no mention is made 
of the hero as a man of science. Should the author ever supply that defi- 
ciency, we take the liberty of recommending to his attention the character of 
Hahnemann. We venture to do so, although we are quite aware that this 
proposal, should it ever reach him, would suggest nothing but the ridiculous 
to his mind, to be expressed by a thousand ludicrous similitudes and illus- 
trations. 



206 ON EPIDEMIC CHOLERA. 

had they long to wait. On the 10th of September 1831, he 
wrote a letter which was published by the editors of the 
Archiv., not suggesting a variety of medicines, which would 
most likely prove suitable, but stating in the simplest and 
most emphatic way what was the sole remedy at the begin- 
ning of the disease. " Every one/' he says, " the instant any 
of his friends take ill of the cholera, must immediately treat 
them himself with camphor, and not wait for medical aid, 
which even if it were good would generally come too late. * * * 
In the first stage camphor gives rapid relief, but the patient's 
friends must themselves employ it, as the stage soon ends 
either in death or in the second stage, which is more difficult 
to be cured, and not with camphor. In the first stage, ac- 
cordingly, the patient must get as often as possible, at least 
every five minutes, a drop of spirit of camphor, (from one 
ounce of camphor to twelve of spirit of wine,) on a lump of 
sugar, or in a spoonful of water/' These orders were given 
by Hahnemann before he had ever seen a case of cholera, 
and now when the epidemic has been treated by hundreds of 
Homoeopathic practitioners, there is nothing in them to change 
and nothing to them to add ; they exhausted the subject. 
Hahnemann not only instantly saw the right remedy, but the 
right dose. This was from no modification of his principles 
to meet the cholera. In the preface to camphor in the 
Heine Arzneimittellehre, published in 1820, (if we mistake 
not, the second edition is 1825,) Hahnemann recommends a 
grain of camphor, dissolved in eight grains of alcohol, to be 
diffused through 400 grains of luke-warm water, and does 
not speak of any further dilution, but says that it should be 
administered in very frequently repeated doses. He says it 
is useful as a palliative in a form of influenza, which is en- 
demic in Siberia, and spread over Europe at one time. 
It is important to bring into view that Hahnemann before- 



ITS TREATMENT— CAMPHOR. 207 

hand, upon the principles he discovered and taught, recom- 
mended large doses of camphor in the treatment of cholera, 
and, according to the same principles, small doses of other 
medicines in this and other diseases. "We cannot help think- 
ing, that if those who are in the habit of systematically 
reviling the name of Hahnemann really knew how much 
good sense, independently of all their other qualities, there 
is in his writings, they might be led to pause before com- 
mitting themselves against him any further; and w r e are 
glad there is a prospect of obtaining access to his lesser 
writings through a translation which we can venture to 
guarantee as accurate and able, although we have not seen 
it.* Not only would the avowed foes of Homoeopathy learn 
much by studying his writings, but we are of opinion that 
many of his followers, who are now seeking to enlarge Hahne- 
mann, have no just idea of his real limits, and if instead of 
making against him, to whom we owe everything, the accu- 
sation of bigotry, they were with the meekness of true wisdom 
to study and ponder his works, they would delay their cen- 
sure, and admit that when their experience amounted to a 
hundredth part of his, it would be time enough to dogmatize. 
The dogmatism of genius, by which the lives of thousands are 
saved, is a very different thing from the dogmatism of the 
neophyte, who must understand the process by which the 
preserver of life attains his conclusions, before he will admit 
them to be true. 

Admitting the great law of healing to be, that " like cures 
like/' now that we know camphor to be the remedy for 
cholera, we are only surprised that it should have required 
Hahnemann to discover the fact. For nothing can be more 
similar than the effects of camphor and the premonitory 

* Hahnemann's Lesser Writings, translated by Dr. R. Dudgeon. Headland, 
London. 



208 ON EPIDEMIC CHOLERA. 

symptoms of cholera. Professor Jorg of Leipzig undertook 
a series of experiments to disprove Homoeopathy.* The follow- 
ing are the effects he describes as resulting from camphor. 
We translate them from the condensed notice by Wibmer.-[- 

Jorg, after taking half a grain of camphor, felt a sense of 
heat in the stomach ; during the night, severe pain in the 
region of the solar plexus (bauch-ganglion.) The next day 
he had a dull headach ; a whole grain caused heat of 
stomach ; after two hours' perspiration, a quick pulse ; 
thirst ; rush of blood to the head. In the afternoon, shak- 
ing of the hands for half an hour. In the evening, pressive 
pain about the solar plexus. A grain and a half caused 
warmth ; perspiration. In the evening, again severe pres- 
sive pain in the solar plexus, which extended upwards to the 
lungs and caused cough. The pulse was accelerated ten 
beats, and the night was uncomfortable. In the morning, 
there was a dull sensation in the abdominal region, and tor- 
pidity of the colon. Two grains caused warmth, perspira- 
tion, eructation, griping, enuresis, inclination to stool. In 
the evening, again pain in the plexus, slight thirst, and a 
restless night. 

The observations of Jorg are fully confirmed by various 
experimenters. Among the morbid phenomena observed 
in the bodies of animals poisoned by camphor, is one of 
especial interest to us, which is, that the heart was no longer 
contractile, although examined immediately after death.j 
The operation of camphor seems even to throw light upon the 
pathology of cholera. It seems to act through the medium 
of the pneumogastric nerves upon the solar plexus, the 

* See a Review in the British Journal of Homoeopathy, vol. iii. of the Writings 
of Jorg. 

f Die Wirkung der Arzneimittel und Gifle an gesunden thierischen Korper. 
Band 3d. Miinchen, 1837. 

J Christison on Poisons, 4th edition, p. 910. 



ITS TREATMENT— CAMPHOR. 209 

lungs, heart, and intestines, exactly as we have suggested, as 
the probable action of the proximate causes of cholera. 

All that remains now to be done is to give the symp- 
toms of camphor, as observed by Hahnemann, which vindi- 
cate his selection of it for the cure of cholera. 

General symptoms. — Excessive weakness ; languor ; and 
heaviness of the whole body ; uncommon failing of strength ; 
uneasiness ; uncomfortableness in the whole body ; he tosses 
about in his bed ; painful sensitiveness to the least touch ; 
difficult motion of the limbs ; spasms ; convulsions ; cramps ; 
he rubs his forehead, chest, and other parts ; knows not how 
to describe his feelings ; he leans against something ; his 
senses vanish ; he glides and falls down ; the limbs being 
rigid and extended ; the shoulders drawn backwards ; the 
arms being a little curved in the beginning of the paroxysms ; 
the hands bent towards the extensor surface of the arm, and 
the fingers being somewhat clenched and set apart from 
one another ; afterwards parts of the body are stretched 
and stiff, with head bent sideways ; the lower jaw rigid and 
wide open ; the lips drawn inwards ; the teeth clenched ; 
eyes closed, with unceasing distortions of the muscles of the 
face ; cold all over, and breathless for a quarter of an hour ; 
the tetanic fit, with loss of consciousness, and vomiting, is 
followed by a complete inability to recollect, as if he had no 
memory ; frequent fits of vertigo ; fainting fits ; foaming at 
the mouth ; coldness of the body ; trembling ; confusion of 
ideas ; delirium. 

Skin. — Pale, withered, shrivelled skin ; heat of skin ; 
bluish and cold ; with coldness all over the body. 

Sleep. — Insomnia ; strong desire to sleep ; yawning and 
drowsiness. 

Fever. — Shuddering ; chilliness, and gooseflesh over the 
whole body ; chills and chattering of the teeth ; coldness of 



210 ON EPIDEMIC CHOLERA. 

the body, with paleness ; copious cold sweat ; full quick 
pulse ; small hard pulse, becoming more and more slow ; 
slower pulse ; weak, small pulse. 

Moral symptoms. — Stupefaction of the senses, resembling 
a swoon ; insensibility ; loss of consciousness ; great anguish ; 
confusion of ideas ; delirium. 

Head. — Vertigo ; headach ; throbbing pressure in the 
temples. 

Eyes. — Blue rings round the eyes ; balls of the eyes turned 
upwards ; staring ; inflamed eyes ; obscuration of sight. 

Ears. — Noises in the ears. 

Face. — Pale countenance ; countenance at first pale, with 
eyes closed, but afterwards staring and open ; the eyes look- 
ing upwards ; spasmodic contortion of the facial muscles. 

Throat. — Violent burning in the palate, down the oeso- 
phagus, causing a desire for drink, but remaining in spite 
of drinking ; soreness on swallowing. 

Appetite. — Excessive thirst. 

Stomach. — Nausea ; inclination to vomit, followed by at- 
tacks of vertigo ; cold sweat, especially on the face at the 
commencement of vomiting ; bilious vomiting streaked with 
blood ; pain in the stomach ; violent pressure in the pit of 
the stomach ; cooling sensation, especially in the pit of the 
stomach ; burning in the stomach. 

Abdomen. — Trouble from flatulence ; cold feeling in the 
epigastrium and hypogastrium ; burning in epigastrium and 
hypogastrium ; cramps in abdomen. 

Stool. — Constipation ; involuntary diarrhoea ; desire for 
stool ; passing but little, followed by an urgent desire, and 
a still less discharge of faeces. 

Urine. — Painful micturition ; burning of the urine during 
emission. 

Larynx. — Roughness of voice. 



ITS TREATMENT — CAMPHOR. 211 

Chest — The breathing is almost stopped ; oppression of 
,the chest ; pressure at the top of the sternum as from a load ; 
oppressed, anxious, panting breathing ; difficult, sluggish 
respiration. 

Trunk. — Painful stitches in back ; tensive pain in the 
muscles of the nape of the neck, increased by movement. 

Arms. — Tearings in the arm ; stitches in the forearm. 

Legs. — Tearing in the thighs ; tearing cramp-pain in the 
dorsum of the foot, along the outer surface of the calf to the 
thighs ; difficult motion and weariness of limbs ; cramps in 
the calves of the legs. 

In conclusion, we may observe that there is the most per- 
fect unanimity among all Homoeopathic practitioners as to 
the efficacy of camphor in curing the first stage of cholera, 
and the practice of administering this medicine was adopted 
in the general hospitals of Petersburgh. In Glasgow, also, 
when the cholera prevailed, " homoeopathic camphor" was 
extensively sold by the ordinary druggists, and the ordinary 
practitioners are said to have prescribed it in pills. 

The contrast between the opium and brandy recommended 
by the Board of Health, and the camphor recommended by 
Hahnemann, is as great as the attention with which the two 
are likely to be received in this country. Camphor is a cer- 
tain, direct, and harmless cure of the first stage of cholera. 
Opium and brandy are narcotics ; uncertain in their benefi- 
cial operation, certain only in their deleterious action. It 
is not even pretended that they can cure cholera, but only 
that sometimes they stop something which sometimes pre- 
cedes cholera. 

It is our firm belief, from all we have seen and heard, that 
camphor is an almost infallible remedy for cholera, if given 
at the very outset of the attack. Every household should 
get a bottle of tincture of camphor to administer whenever 



212 ON EPIDEMIC CHOLERA. 

the slightest symptoms of the disease appear. It is useless 
if not given within the first few hours. If the Government 
would appoint a Commission to inquire into this matter, we 
are confident that the evidence adduced would convince it 
of the propriety of making a similar recommendation. But 
of this we have little hopes. 

"We have spoken of the cure of the first stage of cholera, 
and the means by w T hich it may be effected ; we now come 
to speak of the treatment of the second and third stages, 
for we cannot separate these two in a therapeutic point of 
view. The transition is immense. The first stage may be 
cured by any person who knows the one proper medicine to 
give ; the next stages require skilful treatment ; and even 
in the hands of the most judicious and attentive the issue is 
often fatal. The difference between the two is like that be- 
tween the suppression of an evil thought and the undoing 
of a wicked deed. The pathology of the disease would it- 
self have led us to this conclusion, independently of experi- 
ence ; for it is quite manifest that a disease in which there 
is a disorganization of the blood must be difficult to manage. 
The stream of life, which supplies all the materials for the 
growth and maintenance of the body, is poisoned, and we 
cannot remove the poison, therefore we cannot cure cholera 
when it is fully developed. But we can do much to neu- 
tralize the bad effects of this poison upon the system, and 
thus we can treat the disease much more successfully than 
Allopathic practitioners. A patient ill of cholera may be 
regarded as a person poisoned ; if the poison be very virulent, 
he dies ; if not, he may recover, if we antidote its physiologi- 
cal effects upon the animal economy by appropriate remedies. 

We feel the more called on to make these preliminary ob- 
servations from remembering our utter despair, when we 
first treated the disease, at finding, despite of all our boasted 



ITS TREATMENT — ARSENIC. 213 

remedies, every patient died. This is a common experience, 
and we would warn our brethren to be prepared to find all 
their efforts baffled. By and bye, when the cases were not so 
rapid, and the poison apparently not so virulent quoad the 
persons, the number of our recoveries rapidly increased. So 
we w r ould say to others, " Go on treating all you can, and be 
not disheartened although they all die ; things will mend if 
you persevere/' We propose now to give a detail of the 
various medicines which have been employed in treating the 
second and third stages of Cholera ; and we shall give an ana- 
lysis of the symptoms of each medicine which resembles in 
its operation those of the disease, and practical comment- 
aries upon its administration. As we look upon this as the 
most important and incomplete part of this work, we trust 
that those who may acquire experience in the treatment of 
the disease may direct their special attention to its correc- 
tion and completion. 

Arsenic is the remedy in which we have far the most faith, 
after the period for the administration of camphor is passed. 

An attentive study of the operation of arsenic fully war- 
rants this confidence in its curative power in cholera. It 
evidently has a deep action on the vitality of the body, in- 
dependently altogether of its local irritant effect, and this 
action, like that of the cholera poison, shows itself in many 
ways, but the most characteristic symptom is simply death. 
The following quotation from Dr. Christison's exhaustive 
treatise upon poisons will bring this out better than anything 
else we can collect, and it is confirmed by the observations 
of Orfila :— 

" In the Medical and Philosophical Journal of New York 
is related the case of a druggist, who swallowed an ounce of 
powdered arsenic at once, and died in eight hours, after two 



214 ON EPIDEMIC CHOLERA. 

or three fits of vomiting, with slight pain and heat in the 
stomach. — A similar case has been related by Metzger. A 
young woman died in a few hours, after suffering from 
trivial diarrhoea, pain in the stomach, and strangury ; her 
death was immediately preceded by slight convulsions and 
fits of suffocation ; and on dissection the stomach and intes- 
tines were found quite healthy. Half an ounce of arsenic 
was found in the stomach. — A third case, similar in its parti- 
culars to the two preceding, was submitted to me for inves- 
tigation by the Sheriff of this county in 1825. The subject, 
a girl fourteen years of age, took about ninety grains, and 
died in five hours, having vomited once or twice, complained 
of some little pain in the belly, and been affected towards 
the close with great faintness and weakness. The stomach 
and intestines were healthy. — A fourth case, allied to these, 
is succinctly told in the Medical and Physical Journal. The 
person expired in five hours, and vomiting never occurred, 
even though emetics were given. — A fifth has been related 
by M. Gerard of Beauvais. The subject was a man so ad- 
dicted to drinking, that his daily allowance was a pint of 
brandy. When first seen, there was so much tranquillity, 
that doubts were entertained whether arsenic had really 
been swallowed ; but at length he was discovered actually 
chewing it. This state continued for nearly five hours, 
when some vomiting ensued; coldness of the extremities 
and spasmodic flexion of the legs soon followed ; and in a 
few minutes more he expired. — A sixth and very singular 
case of the same kind has been described by Orfila. The 
individual having swallowed three drachms at eight in the 
morning, went about for two hours bidding adieu to his 
friends, and telling what he had done. He was then pre- 
vailed on to take emetics and diluents, which caused free, 
easy vomiting. He suffered very little till one, when he be- 



ITS TREATMENT— ARSENIC. 215 

came affected with constricting pain and burning in the 
stomach, feeble pulse, cold sweats, and cadaverous expres- 
sion, under which symptoms he died four hours later. Orfila 
justly designates this case as the most extraordinary instance 
of poisoning with arsenic that has come under his notice. — 
A seventh is related by Mr. Holland of Manchester, where 
death took place in the course of eight or nine hours, and 
the symptoms were at first some vomiting, afterwards little 
else but faintness, sickness, a sullen expression, and a gene- 
ral appearance which led those around to suppose the indi- 
vidual intoxicated. — Professor Chaussier has described a 
still more striking case than any yet mentioned. A stout 
middle-aged man swallowed a large quantity of arsenic in 
fragments, and died in a few hours. He experienced nothing 
but great feebleness and frequent tendency to fainting. The 
stomach and intestines were not in the slightest degree af- 
fected during life ; and no morbid appearance could be dis- 
covered in them after death. — A similar instance, not less 
remarkable, has been communicated to me by Mr. Macaulay 
of Leicester, where the individual died with narcotic symp- 
toms only within two hours after taking nearly a quarter of 
a pound of arsenic. — Another, fatal in four hours, has been 
described by Mr. Wright, where the symptoms were vomit- 
ing under the use of emetics, great exhaustion, feeble hur- 
ried pulse, cold sweating, drowsiness, and finally stupor. In 
this case the quantity of arsenic taken was about an ounce. 
— Another of the same nature is recorded by Morgagni. An 
old woman stole and ate a cake, which had been poisoned 
with arsenic for rats. She died in twelve hours, suffering, 
says Morgagni, rather from excessive prostration of strength 
than from pain or convulsions. — The following case related 
by M. Laborde is most remarkable in its circumstances. A 
young woman was caught in the act of swallowing little 



216 ON EPIDEMIC CHOLERA. 

fragments of arsenic, and it afterwards appeared that she 
had been employed most of the day in literally cracking and 
chewing lumps of it. When the physician first saw her, the 
countenance expressed chagrin and melancholy, but not suf- 
fering. After being forced to drink she vomited a good 
deal, but without uneasiness. Two hours afterwards her 
countenance was anxious ; but she did not make any com- 
plaint, and very soon resumed her tranquillity. Five hours 
after the last portions of the poison were taken she became 
drowsy, then remained perfectly calm for four hours more, 
and at .length, on trying to sit up in bed, complained of slight 
pain in the stomach, and expired without agony. A clot of 
blood was found in the stomach. Dr. Platner of Pavia 
describes a case, fatal probably in five hours, where the symp- 
toms were a tranquil, melancholic expression, great coldness, 
paleness of the features, slow languid pulse, retarded respira- 
tion, and suppression of urine, but no pain or swelling of the 
belly, and no diarrhoea till near death, when there was one 
copious fluid evacuation. Lastly, Dr. Choulant has related 
the case of an elderly female who got a thimbleful of arsenic 
in soup, and died in eleven hours, affected with occasional, 
easy vomiting, uneasiness, thirst, and undefinable uneasiness 
in the chest, but without pain of any kind, or any other com- 
plaint. 

" The cases, of which an abstract has here been given, 
will, it is apprehended, be sufficient to correct the erroneous 
impression of many, — that arsenic, when it proves fatal, 
always produces violent and well-marked symptoms It 
will of course be understood that cases of the present kind 
pass by insensible shades into those of the first class, — the 
following for example, being intermediate between the two : 
A young man had frequent vomiting and diarrhoea, which 
were supposed to depend on indigestion merely, as the 



ITS TREATMENT— ARSENIC. 217 

countenance was calm, without any appearance of suffering, 
the appetite tolerable, and the abdomen quite free of ten- 
derness. The pulse, however, quickly sunk, the voice failed, 
and death took place in eleven hours ; and on dissection, 
about twenty grains of arsenic were found in the stomach, 
with strong signs of inflammation.— In a case communicated 
to me by a former pupil, Mr. Adams of Glasgow — that of a 
woman who died five hours after taking six drachms of 
arsenic, there was some vomiting not long after she swal- 
lowed it ; but subsequently she presented no prominent 
symptoms except a ghastly expression, redness of the eyes, 
a fluttering pulse, and extreme prostration, until within half 
an hour before death, when the action of an emetic and the 
stomach-pump was followed by severe burning pain/'* 

The last case is so like one of cholera, that we are sure if 
the epidemic were prevailing it would have passed for a 
severe seizure of the disease. 

We look upon arsenic as a forlorn hope in those very bad 
cases where there are hardly any symptoms present except 
coldness, lividity, thirst, a fluttering pulse, or no pulse, and 
great apprehension (alas ! often too well founded*)-) of imme- 
diate death. In this class of cases, of which several will be 
found among those we have published, we should be inclined, 
had we to treat them over again, to give nothing but arsenic, 
and that, too, in the largest dose we ever employ. We should 
give a drop of the first centesimal dilution every half-hour, 
and no other medicine. The general experience of Homoeo- 
pathic practitioners is in favour of the great value of arsenic 
in the cholera. 

The mode of administration must depend upon the nature 
of the case. If there is not constant vomiting, we should 

* Cliristison on Poisons, pp. 308-311. 

f " Je suis un homrae perdu," were the last words of Marshal Bugeaud. 



218 ON EPIDEMIC CHOLERA. 

advise a drop of the tincture of arsenic to be mixed with a 
tea-cupful of iced water, and given as a dose every half-hour. 
This relieves the thirst, and it is probable that it will be more 
effectual than when given in a smaller quantity of water. 
If, on the other hand, nothing will remain on the stomach, 
then a drop of the tincture may be put upon the tongue. 
We would advise its continued administration throughout 
the whole period of the collapse, unless some special and 
urgent symptoms, indicating other medicines, supervene. 

Of the whole number of cases treated at the Edinburgh 
Dispensary, seventy-five were treated with camphor and 
arsenic alone; of these, fifty-six recovered, and nineteen died. 

We shall now give the symptoms of arsenic as detailed by 
Hahnemann, from whose pages Dr. Christison, who is not 
supposed to have any partiality to Homoeopathy, selects his 
description of the effects of the poison. .This is a remarkable 
tribute, considering how many have written about the effects 
of arsenic, both before and after Hahnemann had published 
his treatise, " Uber die Arsenic — Vergiftung ;" and how 
perfectly able the erudite Professor was to pronounce a sound 
judgment upon this point 

The following symptoms are extracted from Hahnemann, 
and we have put in italics those which we consider most 
characteristic of the true features of cholera : — 

General symptoms. — General rapid sinking of strength ; 
excessive debility ; weakness, obliging him to lie down, with 
inability to leave the bed ; vertigo when rising from the re- 
cumbent posture ; falls down suddenly on rising with vertigo ; 
restlessness ; weakness, with dropping of the lower jaw ; 
sunken, extinct eyes, and open mouth ; pains in the whole 
body ; excessive, intolerable spasms ; tetanic spasms ; con- 
vulsions, with frightful contortions of the limbs ; trembling 
of the limbs ; stiffness and inability of the limbs, with vio- 



ITS TREATMENT— ARSENIC. 219 

lent tearing pains ; burning, corrosive pains ; the pains seem 
intolerable, drive' one to despair and frenzy; shuddering 
coldness ; heat in the face and body ; anguish ; fainting fits ; 
grinding of the teeth ; loss of consciousness. 

Skin. — Coldness ; dry and cold ; covered with cold, clammy 
sweat. 

Sleep. — Sleeplessness, with uneasiness and tossing about ; 
starting during sleep as in a fright. 

Fever. — Coldness of the limbs ; general coldness, with 
parchment-like dryness of the skin, or profuse sweat ; chilli- 
ness ; violent ; with shaking ; internal heat ; cold y clammy 
sweat ; pulse quick, small, rather hard ; rapid, feeble, inter- 
mittent ; small, feeble, frequent ; intermittent; suppressed. 

Moral symptoms. — Melancholy, sadness ; violent anguish ; 
anguish of death ; anguish, with fainting fits ; driving 
him out of his bed ; with tremor ; cold sweat on the face, or 
tearing in the abdomen ; he despairs of his life ; great fear 
of death ; delirium ; loss of consciousness. 

Head. — Beating pain in the head ; humming in ears ; 
nausea ; inclination to vomit when raising oneself in bed. 

Eyes. — Inflammation of eyes ; dull staring eyes, without 
lustre, turned upwards ; almost complete blindness ; dull 
eyes surrounded with blue circles. 

Ears. — Humming in the ears ; roaring in the ears, par- 
ticularly during the paroxysms of pain ; deafness. 

Face. — Sunken countenance ; pale, death-coloured face ; 
yellow ; livid ; bluish, sickly colour of the face ; lead-co- 
loured ; disfigured ; deathlike ; distorted features. 

Teeth. — Spasmodic grinding of the teeth. 

Mouth. — Blackish colour round the mouth ; bluish lips ; 
tongue bluish or white ; great dryness of the mouth ; foetid 
smell of the mouth ; loss of speech. 

Throat. — Burning in the pharynx ; painful, difficult de- 



220 ON EPIDEMIC CHOLERA. 

glutition ; the throat feels very dry, with constant desire to 
drink. 

Appetite. — Violent, unquenchable, burning, suffocative thirst, 
obliging him to drink frequently, although little at a time ; 
sdeirefor cold water ; loss of appetite, with violent thirst. 

Stomach. — Frequent hiccough ; nausea, with great an- 
guish ; empty retching ; vomiting ; vomiting of everything 
he eats or drinks ; excessive vomiting of what he drinks 
with great exertions ; vomiting of yellow, green mucus, and 
bile ; vomiting of fluid, bluish, dingy-yellow substances, fol- 
lowed by great exhaustion; of brownish or blackish sub- 
stances, with great exertions and aggravations of the pains 
in the stomach, sometimes mixed with blood ; vomiting of 
blood ; of blood and mucus ; bloody discharges by the mouth 
and rectum ; vomiting, with diarrhoea ; during the vomiting, 
violent pains in the stomach ; internal burning heat and 
thirst ; soreness in the abdomen ; violent screams ; appre- 
hension of death ; excessive pain in the stomach and pit of 
the stomach ; pressure at the stomach ; burning in the pit 
of the stomach ; spasmodic pains in the stomach ; excessive 
with thirst ; with violent colic, diarrhoea, and fainting fits ; 
drawing in the stomach ; heat and burning in the stomach 
and pit of the stomach, with pain and oppression ; in the 
chest and stomach, with tightness and oppression. 

Abdomen. — Borborygmus; excessive pains in the whole 
abdomen, with vomiting, and diarrhoza ; in the hypogastrium ; 
pains, accompanied w r ith great anguish, lamentations, tossing 
about ; internal restlessness, which does not allow one to lie 
still ; despair of ones life ; spasmodic pains in abdomen ; 
tearing in abdomen, with icy coldness of hands and feet, and 
cold sweat on face ; cold and chilly sensation in the abdo- 
men ; burning in the abdomen, with heat and thirst ; swel- 
ling of the abdomen. 



ITS TREATMENT— ARSENIURETTED HYDROGEN. 221 

Fceces. — Constipation ; ineffectual urging ; tenesmus, with 
burning and pressing in the anus and rectum ; unperceived 
involuntary discharge of faeces ; diarrhoea ; violent with fre- 
quent discharges ; with vomiting ; with great weakness ; with 
thirst; evacuations, burning, yellow, watery, dark-green, 
greenish, dark-brown ; bloody evacuations, with vomiting and 
excessive colic. 

Urine. — Frequent urging to urinate ; diminished dis- 
charge of urine with burning ; suppression of the secretion of 
urine. 

Larynx. — Hoarseness-, unequal voice ; at times strong, at 
times feeble. 

Chest. — Anxious and oppressive shortness of breath ; pain- 
ful breathing; moaning breathing; oppression; laboured 
breathing ; arrest of breathing ; from pain in the pit of the 
stomach ; from anguish and pain in the abdomen ; suffoca- 
tive oppression, and arrest of breathing ; foetid breath ; pal- 
pitation of the heart. 

Trunk. — Pains in the back, with uneasiness and anxiety ; 
contortion of the muscles. 

Arms. — Drawing and tearing in the arms ; the hands are 
stiff and insensible ; cramp in the hand ; coldness of the 
hands ; painful cramp in the fingers ; rigidity of the fingers ; 
drawing, darting, and tearing from the fingers to the shoul- 
ders ; sickly colour of the nails. 

Legs. — Drawing, tearing in the hips ; violent pain in the 
limbs ; cramp in the thighs, calves, and toes ; cramp in the 
calf; hardness in the calf as if pressed fiat, with coldness ; 
stiffness and lameness of the leg. 

The medicine next in order to arsenic, both from its 
chemical and physiological affinities, is Arseniuretted Hydro- 
gen. We do not think it is necessary to give a detail of the 



222 ON EPIDEMIC CHOLERA. 

symptoms of this substance, and prefer quoting the following 
observations from Dr. Christison's work : — 

" Analogous to the effects of inhaling oxide of arsenic are 
those lately observed from the incautious inhalation of ar- 
seniuretted-hydrogen gas. Gehlen the chemist died of this 
accident ; but no particular account has been published of 
the symptoms he suffered. Two cases, however, have been 
minutely detailed within a few years. In one of these, which 
has been related by Dr. Schlinder of Greifensberg, the indi- 
vidual inhaled in forty minutes about half a cubic inch of 
the gas, which is equivalent to about an eighth of a grain of 
arsenic. In three hours he became affected with giddiness ; 
and soon afterwards with an uneasy sense of pressure in the 
region of the kidney, passing gradually into acute pain there 
and upwards along the back. General shivering ensued, 
with coldness of the extremities, and gouty-like pains in the 
knees, shoulders, and elbows. The hands and lower half of 
the forearms, the feet and legs nearly to the knees, the nose 
and region of the eyebrows, felt as if quite dead, but with- 
out any diminution of muscular power. There was also acute 
pain in the stomach and belly generally, painful eructation 
of gas, and occasional vomiting of bitter, greenish-yellow 
mucus. The most tormenting symptom, however, was the 
pain in the kidneys, which soon became attended with con- 
stant desire to pass water, and the discharge of deep reddish- 
brown urine mixed with clots of blood. The whole expres- 
sion of the countenance was altered, the skin becoming dark- 
brown, and the eyeballs sunk, yellow, and surrounded by a 
broad livid ring. Warm drink brought out a copious sweat, 
and removed the sense of numbness ; but next day there was 
little change otherwise in the symptoms, except that the 
urine was no longer mixed with clots, and that the hair on 
the benumbed parts had become white. On the third day 



ITS TREATMENT — ARSENIURETTED HYDROGEN. 223 

the pains had abated, and the urine became clear ; but there 
was hiccough, an excited state of the mind, and a feeling as if 
a great stone lay in the lower belly. In seven days, he was 
much better. In the third week, the whole glans and pre- 
puce became covered with little pustules, which were fol- 
lowed by small ulcers. It was not till the close of the 
seventh week that he recovered completely. — Dr. O'Reilly 
has related the following case, which arose from the inhala- 
tion of hydrogen gas impregnated with arseniuretted-hydro- 
gen, in consequence of the sulphuric acid used for dissolving 
zinc having contained arsenic. Mr. Brittan, a Dublin 
chemist, wishing to ascertain the effects of hydrogen on the 
body, proceeded to inhale 150 cubic inches of it. Imme- 
diately after the second inhalation, he was seized with con- 
fusion, faintness, giddiness, and shivering, and passed a stool, 
as well as two ounces of bloody urine, but without any pain. 
Pains in the limbs followed, and in two hours frequent vomit- 
ing and dull pain in the stomach. The pulse at this time was 
90, the skin cold, and the voice feeble. Ammonia, laudanum, 
and emollient clysters gave him little relief. During the 
subsequent night there was frequent vomiting and no urine ; 
the face became copper-coloured, and the rest of the body 
greenish ; there was tenderness of the epigastrium and hic- 
cough ; but he was free of fever. On the third day, there 
was diarrhoea, and still no urine ; but the jaundice had dis- 
appeared. On the fourth, the breath was ammoniacal, 
and somnolency had set in. On the fifth, the skin became 
again deeply jaundiced, and the face was (edematous ; no 
urine had yet been discharged, and the bladder, examined 
with the catheter, was found empty. On the evening of the 
seventh day, he expired. On examination of the body, two 
pints of red serum were found in the pleural cavities ; the 
lungs were sound, the heart pale and flaccid, the liver indigo- 



A-v^«*w.-:t-\i 



224 ON EPIDEMIC CHOLERA. 

blue, the gall-bladder distended with bile, the kidneys also 
indigo-blue, the stomach empty, and its villous coat brittle, 
with here and there inflamed- like spots on it, the bladder 
empty, the brain bloodless, the cellular tissue generally an- 
asarcous. Arsenic was detected in the pleural serum. By 
an approximate calculation it was supposed that the hydro- 
gen this gentleman inhaled had contained the equivalent 
arsenic of twelve grains of the oxide."* 

We tried it only in one case, which, although a very bad 
one, recovered. We should be inclined to use it frequently 
in cases of great collapse, particularly when the vomiting 
prevented any medicine remaining in the stomach. 

The introduction of ether and chloroform opens an impor- 
tant consideration as to the propriety of giving medicines by 
inhalation. Many and obvious advantages attend this mode 
of administration. One of the most important is the vast sur- 
face upon which the remedy may act. In such a rapid and 
powerful disease as the cholera, it is of the utmost consequence 
to produce a prompt antagonistic effect. This may be done 
by applying the specific in the form of vapour to the lining 
membrane of the lungs, better than by any other means. There 
are certain mechanical difficulties attending the process which 
we doubt not might easily be overcome by a little ingenuity. 
Perhaps the best way of giving it would be to diffuse it 
through water ; moisten a sponge with this arseniuretted 
water, and hold it near the patient's mouth and nose, so that 
he might inhale the disengaged gas, which would be con- 
siderably diluted. We must recollect, however, that this 
substance is a most virulent poison, and the greatest caution 
is necessary in using it. 

Veratrum album has a great and traditional celebrity for 
* Christison, pp. 326-328. 



ITS TREATMENT— VERATRUM. 225 

the cure of cholera. The following case is recorded in 
the works ascribed to Hippocrates : — " A young Athenian 
affected with cholera evacuated upwards and downwards with 
much suffering, nothing could arrest the vomiting or alvine 
evacuations. His voice failed, he could not stir from bed. 
His eyes were lustreless and sunken. He had convulsions 
of the lower extremities from the abdomen downwards. He 
had hiccough, and the stools were more copious than the vo- 
mitings. He took veratrum in lentil juice/'* and recovered. 
Hippocrates was an unconscious homoeopathist. Had he 
lived after Hahnemann, he would have gloried in a profes- 
sion of its principles, and utterly disavowed those who now 
call themselves by his name. Just as Abraham would have 
been a Christian had he lived after the introduction of 
Christianity, and disowned as not his real children those who 
now bear his name, and prefer the exaltation of a race to the 
salvation of a world. 

Veratrum was the medicine in highest repute during the 
former epidemic. Fleischmann gives it usually alternately 
with arsenicum. And in the prevalence of Cholera in Peters- 
burgh, Miiller mentions that it was the favourite remedy in 
the Homoeopathic Hospital there. He says that it was given in 
tincture; but we rather suspect his accuracy on this point, for the 
reason he alleges for its administration is its supposed action 
upon the solar plexus of nerves. Such a hypothetical reason 
for the selection of medicine could have no place in the mind 
of a disciple of Hahnemann. We imagine that observing its 
utility he explained it in this way, and supposed that it was 
by this road we were led to it. However, nothing can be 
clearer than the Homceopathicity of veratrum for cholera, 
in general ; we doubt whether it be so perfectly suited to the 
present epidemic cholera as arsenicum ; at least as far as our 

* De Morb. Popul., lib. v., \ iv. Quoted by Dudgeon. 
P 



226 OTST EPIDEMIC CHOLERA. 

experience goes, we feel at present inclined to trust it more 
in cases of violent vomiting and purging, and all the other 
prominent phenomena of cholera, but which are destitute of 
what we should call the essential physiognomy of the disease. 
Such cases will pass for cholera in all reports, Homoeopathic 
and Allopathic, and they will be cured ; but to a practised 
eye there is something about them different from fatal cases, 
at the very outset. The disease seems to be going inwards, 
advancing towards the seat of life ; not coming outwards 
from it. That they are often fatal, there is no doubt ; and 
that veratrum cures them, we have no doubt either ; but still 
veratrum is not sufficient in the worst type of the disease : 
and the reason of its great exaltation is, that it cures so 
many curable cases very like true cholera. We are by no 
means prepared to say that it is not of great service in the 
treatment of cholera, but believe that its utility has been 
somewhat overrated. We have found it most useful in cases 
where there was violent purging and vomiting, without that 
sudden deadly collapse which we characterized as the indi- 
cation for arsenicum. Whether it is advisable to give it 
alternately with arsenic, is a difficult question, on which we 
feel some hesitation in venturing. We should be rather in- 
clined to stop the arsenic for a while, and give veratrum in 
pretty large doses ; the 1st, 2d, or 3d dilution,; pretty fre- 
quently for some little time, and then return to the arsenic. 
However, we should be sorry to dogmatize on this matter, for 
we are far from having come to a clear principle of guidance 
in it. The only vehicle for its administration is water, and 
it may be given either in a large or small quantity, accord- 
ing to circumstances. When there was great insensibility 
and dryness of the mouth and lips, so that swallowing was 
difficult, we have dropped it into the throat by a quill used as 
a pipette. Before detailing the symptoms of veratrum as 



ITS TREATMENT— VERATRUM. 227 

recorded in Hahnemann, which justify its use in cholera, we 
shall give a very good example of the poisonous effects of the 
drug. We may mention in passing, that it is one of the 
oldest poisons, and is supposed to have been used by the Gauls 
and other nations in their gallant warfare with the Romans. 
So that to it Horace probably alludes in his famous ode, in 
which he introduces the " venenatis gravida sagittis." This 
rests on the authority of Pliny, Celsus, and Dioscorides.* 

The following case, quoted by Orfila, is related by Vicat if 
— " A tailor, his wife, children, and workman, took some soup 
in which the root of white hellebore had been put instead of 
pepper. Shortly after, these persons were seized with a gene- 
ral coldness, and their bodies became covered with an icy 
sweat ; their debility was extreme ; they were almost in a 
state of insensibility ; and their pulse could scarcely be per- 
ceived. At the expiration of two hours, the eldest child, 
who was not four years of age, began to vomit copiously, but 
with considerable straining. The rest were shortly after in the 
same condition/' The next case is recorded by Briickmann, J 
and quoted by Wibmer : — " A woman, sixty years of age, had 
taken some powdered hellebore-root by mistake. After an 
hour had elapsed, she was affected with violent burning in the 
throat and stomach ; nausea; she began to retch green mucus; 
she had dysuria (Harnzwang) ; stiffiiess and coldness of the 
whole body ; the pulse was imperceptible ; the perspiration 
occasionally interrupted ; often spasmodic ; the face pale ; 
the pupils enlarged ; sensibility and consciousness were absent/' 

The following catalogue of symptoms are extracted from 
Hahnemann's proving, and we have marked those we wish 
to direct attention to as we did the symptoms of arsenic : — 

* Wibmer, op. cit., v. Band S. 406. 

f Histoire des plantes V6n6neuses de la Suisse, p. 166. 

J Horn's Archiv., 1825, i. 477. 



228 ON EPIDEMIC CHOLERA. 

General symptoms. — Excessive weakness ; he falls down 
from weakness ; sudden failing of strength ; debility in all 
the limbs ; inclines to lie down ; faints at the least motion ; 
pain in the muscular parts of the body, composed of pressure 
and a bruised feeling ; shootings in the body here and there ; 
stiffness of the limbs ; cramp-like drawing above the joints ; 
convulsions in . the limbs, with profuse sweat ; afterwards 
headach, vertigo, and a good deal of drinking ; spasms ; 
convulsions ; epileptic convulsions ; trembling in all the 
limbs ; horrid anguish about the heart; disposition to faint ; 
when rising, he is tormented by a horrid anguish; the fore- 
head being covered with a cold sweat ; nausea ; vomiting ; 
coldness of the whole body. 

Skin. — Coldness of the whole body ; with cold, clammy 
sweats. 

Sleep. — Drowsiness, with starting, as in a fright, prevent- 
ing sleep. 

Fever. — Shuddering ; cold chilliness in the skin ; coldness 
of the whole body ; the whole body feels cold to him and 
others ; internal cold thrill, with thirst; chilliness in the 
limbs, with a drawing pain in the same ; internal heat ; cold 
sweat all over ; cold sweat all over the head and trunk ; the 
pulse collapses ; imperceptible pulse ; there is the usual num- 
ber of pulsations, but the pulse is weak and almost imper- 
ceptible. 

Moral symptoms. — He dreads to talk ; despair ; great 
anguish, anxiety, and vertigo ; sensation in his whole frame 
as if he was going to die ; however he is composed ; tendency 
to start and fearfulness ; loss of memory ; excessive dizzi- 
ness ; loss of sense ; delirium. 

Head. — Headach ; dizziness and humming in the fore- 
head, with dull internal headach. 

Eyes. — The eyes look faint, surrounded with blue rings ; 



ITS TREATMENT — VERATRUM. 229 

the eyes are turned backwards, so that the whites only are 
seen ; loss of sight. 

Ears. — Roaring in the ears. 

Face. — Cold, disfigured face as of a dead person ; face pale, 
cold, hippocratic, wan, with the nose pointed, and a blue circle 
round the eyes ; bluish colour of the face. 

Teeth. — Grinding of the teeth. 

Mouth. — Dryness in the region of the palate and desire 
for water ; dry lips and dry mouth, with thirst ; coldness of 
the palate ; he speaks with a low and feeble voice ; stammer- 
ing ; speechlessness. 

Throat. — Burning in the throat ; dryness in the throat, 
which cannot be removed by drink ; drawing pain in the 
throat ; thirst and colic ; sensation of suffocation. 
Appetite. — Unquenchable thirst, particularly for cold drinks. 
Stomach. — Hiccough, continuing for a long while ; nausea; 
excessive desire to vomit, even to fainting ; vomiting of the 
ingesta ; vomiting of green mucus, afterwards of copious 
froth ; vomiting of a good deal of mucus, with excessive 
weakness ; vomiting of bile and mucus, then of blood ; 
violent, excessive vomiting ; feeling of weakness, with inter- 
nal coldness in the region of the stomach and a slight pres- 
sure ; painful pressure and drawing round the pit of the 
stomach. 

Abdomen. — Loud rumbling in the abdomen ; drawing pain 
deep in the abdomen ; distention of the abdomen ; pains in 
the stomach and intestines ; pinching in the abdomen, at 
times below, at times above the umbilicus. 

Fceces. — Constipation ; sudden, frequent, loose stools ; dis- 
charge of acrid faeces, with tenesmus ; excessive alvine dis- 
charges ; frequent and violent diarrhoea ; chilliness and shud- 
dering, with frequent stools ; extreme weakness during stool ; 
violent, bloody diarrhoea ; the evacuations are accompanied 



230 Otf EPIDEMIC CHOLERA. 

with cold, profuse sweat on the forehead; burning at the anus 
during stool. 

Urine. — Burning ; scanty. 

Chest. — Spasmodic contraction of the intercostal muscles 
of the left side, arresting the breathing ; painful constriction 
of the chest ; excessive anguish affecting the breathing ; cut- 
ting pain in chest ; painful and difficult breathing. 

Trunk. — Pairi in the loins, and tearing pain in the lower 
limbs. 

Arms. — Painful paralytic weakness in the upper and 
lower limbs ; twitching in either arm ; the fingers feel dead. 

Legs. — Cramp-like drawing in the gluteal muscles when 
standing ; cramp-like drawing pain in left thigh when stand- 
ing ; painful heaviness of the legs ; cramp in the calves and 
feet ; coldness in the feet. 

Copper, both in the form of cuprum metallicum and cu- 
prum aceticum, is a very valuable remedy in cholera. The 
cases for which it answers best are those attended with violent 
spasms, and with or without copious discharges ; it does not 
seem of much use when there is great collapse. We prefer the 
acetate of copper to the metallic copper, rather from a general 
belief in the greater certainty and rapidity of the action of 
soluble salts, than from any comparative experience of the effi- 
cacy of the two. If the metallic copper be given, it should be 
given in dry powder, and if the acetate be used, it may be given 
either in solution or in powder, as circumstances indicate. We 
have seen very marked mitigation of the cramps after its ad- 
ministration, and we have great confidence in recommending 
its frequent repetition when these are severe. A dose may be 
given every five or ten minutes. We have generally em- 
ployed the third dilution of the acetate, and have no reason to 
suppose that any other dilution would have answered better. 



ITS TREATMENT — COPPER. 231 

We do not look upon cuprum as at all a specific for cholera, 
but as powerfully curative of one of the most distressing 
group of symptoms. We cannot, therefore, believe that it 
will be of much use as a prophylactic against the disease. 
Indeed, we must confess that we do not think there is 
sufficient evidence in favour of any prophylactic of cholera. 
Of course there can be no harm in wearing a plate of cop- 
per next the skin, as some have recommended ; but we are 
inclined to believe that the taking of medicines daily to 
keep off cholera may have an injurious moral effect, and pre- 
dispose to the disease. It brings the subject continually 
before the mind, and suggests the probability of an attack. 
The fear of cholera goes to such a length in some persons as 
to deprive them of sleep and all enjoyment of life. In such 
cases we should recommend the use of prophylactics, but 
more for the purpose of calming the nervous system than of 
acting homoeopathically in regard to cholera. If we had 
used any protection when attending patients in cholera, it 
would have been camphor. We do not think that a person 
surrounded with a camphor atmosphere could be affected 
with the disease. We believe its poisonous effects would be 
immediately neutralized. The following casgs, reported by 
Dr. Beer of Vienna, are the best specimens we have met 
with of the poisonous effects of copper : — 

" On the 1st of April of this year, at eight o'clock in the 
evening, I received a notice from a surgeon, that, in a certain 
house, several children had been attacked with violent vomit- 
ing without any known cause. A narrower examination af- 
forded me the following particulars : — At twelve o'clock noon 

of the 1st of April, Anna K n gave to three children, viz., 

Franz Krakowetz, aged three years, Elizabeth Fetty, eleven 
years, and Franz Eigenmann, four years, some confectionary, 
of which the children eat a portion on the spot, and, carry- 



232 ON EPIDEMIC CHOLERA. 

ing a portion home, gave some of it to Mary Stacker, aged 
eleven, and Anna Schedel, aged six years. 

" The following symptoms appeared — in the three chil- 
dren who had eaten at dinner of the confectionary imme- 
diately after eating, and in the two who had eaten later some 
hours after the indulgence : — 

" Unquenchable thirst, headach, and giddiness, nausea, dry- 
ness of the mouth, frequent vomiting of a fluid, partly yellow- 
brown, partly blackish-green, severe tormina at the region of 
the navel, suppression of urine, slight tension of the abdomen, 
which was tender on pressure, obstinate costiveness with con- 
stant tenesmus, pain in the small of the back, with cold extre- 
mities, and cold sweat. After the vomiting had somewhat 
subsided, nervous symptoms were superadded, of which the 
chief were — very severe headach, slight delirium, tearing 
pain in the upper extremities, and convulsive movements of 
the lower, particularly in the calves of the leg, great exhaus- 
tion and somnolence, which, in the case of three children, 
amounted to a comatose condition ; the countenance was in 
parts red, in parts very pale. The pulse in four of the chil- 
dren was very small, contracted, and slow ; only in the case 
of Franz Krakpwetz, a plethoric boy, did I find a hard, full, 
quick pulse, with redness of the face and dryness of the skin. 
M. Stacker had six attacks of diarrhoea, and Anna Schedel 
one attack of vomiting of blood and mucus. 

" It is not necessary to mention the chemical process by 
which copper, which must have existed in large quantity in 
the confectionary, was detected. 

" The children seem all to have recovered; hut one of them, 
three weeks after this event, was attacked by jaundice, and 
another of them by a tertian intermittent fever, attended 
with periodic diarrhoea/'* 

* British Journal of Homoeopathy, vol. i. pp. 97, 98. 



ITS TREATMENT— CUPRUM METALLICUM. 233 

Drouard relates that twenty-one Jacobin friars were poi- 
soned by a preparation of copper, and that " in all of them 
the first symptoms were severe headaches, accompanied with 
excessive weakness in the legs and in the whole body ; dull 
pains over the forepart of the thighs, and, in some, cramps 
in the calves of the leg. Those who first felt the action of 
the poison had experienced besides a severe pain in the 
stomach, accompanied with great anxiety of the precordia, 
which is peculiar to it, and a trembling of the limbs/' * 

It will be seen by these cases that vomiting and purging 
are by no means a constant effect of copper ; but pain and 
cramps seem to be so. We shall now give the symptoms 
of cuprum metallicum and cuprum aceticum, as we have done 
of the other medicines. 

CUPRUM METALLICUM. 

General symptoms. — Excessive weakness in the whole 
body ; repeated fainting fits ; uneasiness in the body ; very 
restless ; tremor in all the limbs ; cramps in the limbs ; con- 
vulsive movements of the limbs ; general convulsions ; con- 
vulsions, with continued vomiting and violent colic ; the limbs 
and trunk become rigid. 

Skin. — Cold sweat ; contraction of the skin oqi the limbs. 

Sleep. — Sleeplessness ; oneisunable to fall asleep ; thesleep 
is full of dreams, and interrupted by frequent vomiting. 

Fever. — Chilliness, especially of the hands and feet ; chil- 
liness and chattering of teeth ; shuddering and chills over 
the whole body ; cold sweat for several hours ; moist hand ; 
accelerated pulse ; soft, slow pulse ; slow pulse, twenty-four 
beats a minute ; weak and small pulse. 

Moral symptoms. — Melancholy, and imagines that his 

* Experiences et Observations sur l'empoisonnement par Poxyde de cuivre, 
&c. Par C. R. Drouard, p. 36. Quoted by Orfila, vol. i. p. 218. 



234 ON EPIDEMIC CHOLERA. 

death is imminent and unavoidable ; anguish about the heart ; 
restless tossing about, and constant uneasiness ; his senses 
vanish ; delirium ; incoherent, delirious talk. 

Head. — Attacks of vertigo ; most violent headach. 

Eyes. — Sunken, deep eyes, with blue borders ; red inflamed 
eyes; wandering eyes ; staring and sunken eyes; protruded 
glistening eyes ^dilatation of the pupils; obscuration of sight. 

Ears. — Drumming in the ears ; deafness. 

Face. — Paleness of the face ; bluish face, with bluish lips ; 
changed features, full of anguish; sad, dejected expression 
of the countenance ; spasmodic distortion of the features. 

Teeth. — Spasmodic contraction of the jaws. 

Mouth. — Tongue coated with a white mucus ; he lost his 
speech. 

Throat. — Dryness of the throat, with thirst. 

Appetite. — Excessive thirst. 

Stomach. — Frequent hiccough ; nausea immediately ; vio- 
lent nausea ; nausea, with inclination to vomit ; inclination 
to vomit, accompanied by spasmodic colic ; vomiting ; con- 
tinual vomiting ; violent vomiting from time to time ; violent 
vomiting, with nausea and diarrhoea ; continued vomiting, 
attended with the most horrid colic ; excessive vomiting, 
accompanied by continued pain in the stomach and tenes- 
mus ; frequent vomiting, accompanied by colic and diarrhoea 
resembling cholera ; vomiting of water ; of mucus; of green 
and bitter mucus ; haematemesis ; excessive, horrid pains 
in the stomach and in the region of the stomach ; pressure 
in the pit of the stomach. 

Abdomen. — Pain in the abdomen, with excessive anguish ; 
pressure from above downwards in the abdomen, as if from 
a stone ; painful pressure in the abdomen ; more violent by 
contact ; inflation of the abdomen ; hardness of the abdo- 
men, with great painfulness to the ttmch ; violent spasms 



ITS TREATMENT— CUPRUM ACETIC UM. 235 

in the abdomen and in the upper and lower limbs, with pier- 
cing, torturing screams ; cutting and tearing in the bowels. 

Fceces. — Constipation ; violent diarrhoea ; bloody diarrhoea. 

Urine. — Urgent desire to urinate, with emission of a small 
quantity of urine. 

Larynx. — Hoarseness. 

Chest. — The chest feels contracted ; the breathing is diffi- 
cult, even to suffocation ; constriction of the chest ; suffoca- 
tive arrest of breathing ; stitches in the side ; palpitation 
of the heart. 

Trunk. — Lancination across the small of the back ; violent 
aching in the back, under the right scapula ; lancinating 
tearing in the cervical muscles. 

Arms. — Drawing pain in shoulder ; shock or jerk in left 
upper arm ; drawing pains in lower arms; cold hands; numb- 
ness and shrivelling of the fingers. 

Legs. — Drawing, aching pain in the nates ; great pain in 
the lower limbs ; excessive weakness in the lower limbs ; 
drawing pain in the right thigh ; cramp in the leg from the 
malleolus to the calf; painful jerk or shock below the calf; 
cramp in the calves ; tensive and drawing cramp ; pain in 
the calf ; drawing pain under the calf ; tearing and pressure 
in the leg below the knee-joint ; 'drawing pain in the sole 
of the foot. 

CUPRUM ACETICUM. 

General symptoms. — General muscular weakness and great 
languor ; great restlessness ; fainting turns ; rigidity of the 
limbs and trunk ; bruised and lame feeling in the small of 
the back and lower limbs, accompanied with tearing pains ; 
slight convulsions ; spasms and convulsions ; convulsions ac- 
companying the constant vomiting and violent colic. 

Skin. — Icy cold, especially that of the extremities. 



236 ON EPIDEMIC CHOLERA. 

Sleep. — Starting during sleep. 

Fever. — Feverish heat ; Icy coldness of the body, particu- 
arly of the hands and the feet ; cold sweat ; pulse frequent, 
small, hard, contracted ; at times regular, at others irregular. 

Moral symptoms. — Tendency to start ; great anguish ; de- 
lirium. 

Head. — Giddiness on raising the head ; painful throbbing 
in the temples ; violent headach, with thirst, and violent 
colic, or with extreme weakness. 

Eyes. — The eyes are sunken, staring as if retracted into 
the sockets ; the whites of the eyes are slightly red. 

Ears. — Singing and buzzing in the ears ; deafness. 

Face. — Expression of sadness ; despondency ; excessive 
anguish and intense pain in the face ; cool face ; spasmodic 
distortion of the face. 

Mouth. — Greyish tongue ; moist tongue. 

Throat. — Difficult deglutition. 

Appetite. — Burning, very troublesome thirst. 

Stomach. — Singultus and spasms in oesophagus ; constant 
nausea ; great inclination to vomit ; inclination to vomit, with 
violent gagging and pressure in the stomach ; violent gagging 
and ineffectual effort to vomit ; frequent violent vomiting, 
attended with nausea ; frightful colic ; diarrhma and convul- 
sions ; frequent alternation of vomiting and diarrhoea ; vo- 
miting, with aggravation of the pains in the stomach and 
intestines ; tearing, and frequently very violent pains in the 
stomach ; horrid pains in the stomach and bowels ; crampy 
pressure in the stomach. 

Abdomen. — Violent spasmodic pains in the abdomen ; in- 
tense tearing pain in the epigastric region ; pains in the 
abdomen, causing anguish ; violent colic in the abdomen, 
with frequent tenesmus or frequent diarrhceic stools, and 
violent gagging. 



ITS TREATMENT — SECALE CORNUTUM. 237 

Stool— Constipation ; diarrhoea ; copious, painful, black- 
ish evacuations, sometimes mixed with blood, attended with 
tenesmus and weakness. 

Urine. — Scanty urine. 

Chest. — Difficulty in breathing, and spasmodic contraction 
of the chest ; suffocative arrest of breathing ; oppression of 
the heart ; anxiety about the heart. 

Limbs. — Trembling of the limbs ; spasmodic painful con- 
traction of the fingers and toes ; painful jerking in the hands 
and feet, extending into the upper arms, and passing into a 
cramp of the calves when it reached the legs ; coldness of the 
limbs ; cool hands ; pains in the thighs ; violent cramps in 
the calves, during which the two big toes are tetanically drawn 
towards the soles of the feet with great pain. 

Secale cornutum, or ergot of rye, is a medicine in which 
we have great faith in some of the worst varieties of cholera. 
We have seen the most decided advantage from its adminis- 
tration in cases of very copious discharges both alvine and 
by vomiting. While we would recommend cuprum and 
veratrum to be given rather by themselves than in alterna- 
tion, we should feel inclined to give secale alternately with 
arsenicum. It is not easy to give a reason for this beyond 
the observation, that so given, we have seen more benefit to 
the patient than from either singly ; and we do not think 
that the two medicines interfere. We should give it strong, 
in the first, second, or third dilution ; a dose every half-hour 
alternately with arsenic ; and this in cases, particularly of 
women, where there is great prostration and violent watery 
discharges. We have seen cases, which we looked upon as 
quite hopeless, steadily rally under this treatment ; and we 
have no doubt of the beneficial effects of the remedies. 

By far the fullest account of the effects of ergot of rye is 



238 ON EPIDEMIC CHOLERA. 

that given by Dr. Buchner of Munich, in the 4th vol. of the 
British Journal of Homoeopathy. It is well known that a very- 
fatal disease like an epidemic has frequently prevailed from 
the use of this substance among the poor of France and Ger- 
many. In the district of Guyenne and Sologne alone, there 
died in the year 1770 no less than 8000 persons from this 
poison.* It isdescribed by Taubef as coming on " suddenly 
without any warning ; the patient is attacked with giddiness ; 
dimness of sight ; frightful contortions of the body; trembling 
of the limbs ; cold perspiration ; great anguish ; restless- 
ness ; hippocratic countenance ; intense thirst ; pain at the 
sternum ; oppression of the chest ; the pulse small, intermit- 
tent, often imperceptible." If to this were added vomiting 
and purging, which secale cornutum sometimes produces, it 
would be impossible to discriminate between the ergot dis- 
ease and cholera. 



SYMPTOMS OF SECALE CORNUTUM. 

General symptoms. — Long continued indolence ; great 
general languor ; rapid sinking of strength ; complete pros- 
tration of the assimilative functions ; skin becomes blue and 
cold; spasms; the joints appear as if dislocated, the spasms 
being even of an epileptic or tetanic kind, alternating with 
stiiFness; spasms, attended by violent retching and thirst; 
vertigo ; loss of sense and consciousness ; general livid ap- 
pearance ; violent twitching motions of the voluntary mus- 
cles ; violent convulsions, attended with excessive pain ; during 
the spasms the muscles are constantly trembling, and the 
spasms, which were at first alvine, gradually increased to 
tonic and real tetanic spasm ; violent convulsions of the eoc- 

* Tissot, Nach. v. d. Kriebelkrankheit, 1770. 
f Geschichte der Kriebelkrank. Gott. 1782. 



ITS TREATMENT— SECALE CORNUTUM. 239 

tremities several times a-day ; during the remission the 
fingers remain numb, and frequently contracted ; epileptic 
spasms ; sudden vertigo and blindness ; the patients were 
entirely deprived of their senses, fell down, and had to en- 
dure the most violent contractions of the joints ; convulsions; 
trembling ; violent ineffectual retching ; the elbows were 
pressed to the chest ; the wrist-joints were bent ; the fingers 
clenched ; the heels were drawn upwards towards the tendo 
achillis ; the toes were drawn under the soles of the feet ; 
tetanus ; cold sweat during the paroxysm. 

Skin. — Withered, dry; the skin all over looks lead-coloured; 
drawing and creeping increasing to spasms, with contractions 
of the limbs, and profuse sweats. 

Fever. — Disagreeable feeling of coldness in the back and 
abdomen, also like shuddering, likewise in the extremities ; 
sudden chilly creeping ; violent chilliness also, with shaking ; 
fever, first violent chilliness, afterwards burning heat, with 
unquenchable thirst, the heat being particularly felt in the 
interior, attended with anxiety, which deprives one of the 
understanding ; the pulse is feverish, small, contracted ; 
slow, small intermittent pulse ; the pulse is at times slow 
and full, at others small and tight ; spasmodic, small, ac- 
celerated, and frequently intermittent pulse ; sweat from the 
head to the pit of the stomach ; cold sweat, also viscid. 

Moral symptoms. — Lowness of spirits ; melancholy ; em- 
guish; great and oppressive anxiety, stupor, with prostra- 
tion ; loss of consciousness and sensibility ; consciousness 
continues until his last breath ; delirium. 

Head. — Vertigo ; stupefaction and confusion of the head ; 
headach. 

Eyes. — Sunk ; obscuration of sight ; squinting. 

Ears. — Humming and roaring in the ears; hardness of 
hearing. 



240 ON EPIDEMIC CHOLERA. 

Face. — Wretched complexion ; the face is sunken and pale , 
fceces hippocratica ; unpleasant distortion of the features ; 
livid. 

Mouth. — Thin whitish coating of the tongue ; discoloured, 
brown, and finally black tongue ; grinding with the teeth ; 
voice feeble and inaudible ; inability to speak distinctly ; 
difficult stuttering speech. 

Throat. — Dryness in the throat ; violent burning in the 
fauces. 

Appetite. — Unquenchable thirst ; thirst and dryness of 
the throat. 

Stomach. — Nausea ; vomiting ; violent vomiting ; constant 
retching and pressure in the pit of the stomach ; constant 
pain ; oppression and pressure in the pit of the stomach, with 
constant ineffectual disposition to vomit ; the patients asked 
constantly for drink ; painful sensation in the prsecordia ; 
heat and burning in the pit of the stomach. 

Abdomen. — Violent colic ; great feeling of coldness in the 
back and abdomen ; burning in the abdomen ; distention of 
the abdomen, with pain on touching the parts. 

Stool. — Constipation, with frequent ineffectual urging; 
painful diarrhoea, with great prostration ; putrid and foetid 
colliquative diarrhoea; involuntary diarrhoea; cholera-like 
spasm ; sudden striking change of features, with deep sunken 
eyeballs surrounded with blue margins; constant nausea 
and vomiting after taking the least food; frequent diarrhoea, 
with watery, slimy evacuations ; shrivelled skin, which feels 
cool to the hand ; inexpressible feeling of anxiety and burning 
in the pit of the stomach ; hoarse, hollow voice ; suppression 
of urine ; cramp in the calves ; paralysis of the upper ex- 
tremities ; scarcely perceptible pulse ; unquenchable thirst 

Urine. — Difficult urination, with constant urging in the 
bladder ; burning in the urethra during micturition. 



ITS TREATMENT— NUX VOMICA. 241 

Larynx. — Voice feeble and inaudible. 

Chest — Oppression of the chest ; slow breathing ; thirteen 
respirations a minute; anxious and difficult respiration; 
moaning ; heart-beats infrequent ; violent palpitation. 

Arms. — Weakness and weariness ; violent pains in the 
limbs ; paralysis of the arms ; coldness ; blue colour ; the 
whole hand is drawn in, so that several bones of the carpus 
were pressed outwards ; the whole forearm suffered by the 
spasm ; pain relieved by endeavouring to straighten the 
contracted part ; violent contraction of the fingers ; the 
fingers are violently drawn towards the palm of the hand ; 
the pains are relieved by forcibly straightening the fingers, 
which, however, contract again immediately. 

Legs. — Languor and pains in the lower extremities ; te- 
tanic spasm of the toes ; numbness, insensibility, or coldness 
of the legs ; the limbs become pale, cold, and shrivelled, as if 
they had been lying in water for a long while ; spasms and 
convulsions of the extremities. 

Nux vomica we have found of use in cases distinguished by 
vomiting and cramps. When there is little or no alvine eva- 
cuation, and great suffering from spasms, and sickness with 
pain at the epigastrium before collapse has taken place, we 
should recommend its administration in the dose of a drop 
of a low dilution every ten minutes, either alone or alter- 
nately with arsenicum. We do not think that it has yet 
obtained so high a place in the treatment of cholera as it 
merits, and we should strongly advise any practitioners who 
have the cholera to treat, to give nux vomica early and in 
large often-repeated doses. The following case of poisoning, 
described by M. Ollivier, is one of the best we have yet met 
with. It is referred to both by Wibmer and Dr. Christison. 
Dr. Drogartz, who saw the case a few minutes after the 

Q 



242 ON EPIDEMIC CHOLERA. 

poison had been taken, found the head d^awn back and to- 
wards the left side, the body stiffened and straightened, the 
legs pushed out and forced wide apart, no pulse or breathing 
perceptible, the face and hands were livid, and the muscles 
violently convulsed.* 

General symptoms. — Tearing and heaviness in all the 
limbs, with stiffness in the muscles and joints ; violent pain 
in the muscles at every movement ; convulsions and spasms ; 
stiffness of the limbs ; extremely painful muscular contrac- 
tions, continuing from three to four minutes, after which period 
they are interrupted by a violent spasm ; tetanic spasms ; faint- 
ing fits after making the least exertion ; sudden failing of 
strength. 

Sleep. — Great drowsiness ; during sleep, starting at night, 
and in the daytime when waking. 

Fever. — Coldness of the whole body with blue skin, particu- 
larly of the hands, and blue nails ; the temperature of the skin 
is diminished all over : violent thirst ; flushes of heat ; pulse 
small and quick or intermittent ; collapse of pulse with full 
consciousness. 

Moral symptoms. — Apprehends death, and thinks that death 
is near. 

Head. — Vertigo ; headach. 

Face. — Redness and heat of cheeks ; pale, wretched look 

Throat. — Burning in the oesophagus up to the mouth. 

Stomach. — Nausea ; violent vomiting ; the region of the 
stomach sensitive to pressure ; violent pain in the stomach ; 
cramp-like pains in the stomach with pressure ; burning at 
the pit of the stomach. 

Abdomen. — Cramp-like pains ; burning in the abdomen. 

Fceces. — Ineffectual urging to stool ; frequent urging with 
tenesmus and pressure in the anus, and cutting around the 
* Archiv. Gentfrales deMedecinc, Mai 1825, p. 17. 



ITS TKEATMENT— LACHESIS. 243 

umbilicus ; small stools, mostly consisting of mucus, with 
urging and tenesmus. 

Urine. — Painful, ineffectual desire to urinate. 

Larynx. — Difficult speech. 

Chest. — Shortness of breath ; painful pressure across the 
chest, arresting the breathing ; pain as if the sternum were 
oppressed ; a sort of oppression in the region of the heart, 
rendering breathing difficult ; palpitation of the heart ; ten- 
sion and pressure in the outer parts of the chest, as if op- 
pressed by a load. 

Trunk. — Contractive pain in the small of the back ; tear- 
ing in the back ; contractive pain in the back. 

Arms. — Drawing pains in the arms; cold hands ; cold 
sweat of the palm of the hands ; cramp-like contraction of 
the palm of the hand. 

Legs. — Coldness of the lower limbs; drawing, tearing pain; 
cramp pain in the calves. 

Lachesis and Crotalus Horridus. — We are obliged to unite 
these two potent substances in our description ; for it is well 
known that under the former name both of these snake poi- 
sons generally pass. And we do not think this confusion is of 
much detriment to our present object, which is rather to call 
attention to this class of poisons, as likely to furnish valuable 
remedies in cholera, than to enter into any critical analysis 
either of the symptoms of the medicines, or the particular 
cases where they are likely to be of use. Our experience 
of their utility is too small, but from the general effects they 
produce, we are of opinion, that if we could obtain some 
snake poisons in a pretty concentrated form, they might be 
most serviceable in cholera. 

Besides the careful investigation of the learned and ac- 
complished naturalist and physician, Dr. Hering of Phila- 



244 ON EPIDEMIC CHOLEEA. 

delphia, upon the effects of the poisons of the lachesis and 
crotalus, the chief sources of our knowledge upon this sub- 
ject are the writings of the Abbe Fontana and Dr. Mead, on 
the Viper, and Russell's Indian Serpents. The most in- 
teresting facts disclosed by their investigation, as far as con- 
cerns our present subject, are, that the deadly effects are 
more certain and rapid in warm countries, and warm weather, 
than in cold, that the poison seems to act directly on the 
nerves of organic life, and afterwards affects the blood, and 
that many of the symptoms bear a close resemblance to those 
of cholera. The following quotation from Fontana will, we 
think, be interesting for many reasons — it seems to point to 
the Homoeopathic principle : — 

" In the first place, nothing is more common in medicine, 
than to find substances which, when applied to one part of 
the animal machine, act as a remedy ; instead of which they 
occasion diseases, and even death, when applied to others. 
Several medicines, particularly in the class of poisons, ope- 
rate precisely in this way ; fresh examples of which will be 
given in the continuation of this work. 

" Electricity occasions death by depriving the heart and 
fleshy fibres of their irritability, as I have proved in my 
work on Animal Physics ; and this same electricity is not- 
withstanding one of the strongest stimulants to the muscular 
fibres that is known. It restores life by exciting irritabi- 
lity in the very animals in which it had an instant before 
destroyed it. Amongst all the stimulants that can be em- 
ployed to call the animals back to life, that the electrical shock 
has thrown into a state of insensibility, a proper application 
of gentle sparks appears to me the most efficacious remedy. 

" In the second place, the application of fixed air has a 
very different effect when introduced into the intestines than 
when it is respired. In the first case its action is imme- 



ITS TREATMENT — LACHESIS. 245 

diate ; in the second, it seems to need the assistance of the 
blood to convey its action to the heart. Whence it follows, 
that its effects may be very different in these two circum- 
stances. 

" These particulars naturally led me to think, that the 
venom of the viper likewise kills animals by destroying their 
irritability. I procured fifty of the strongest and largest 
frogs I could meet with. I preferred these animals because 
they are livelier than others ; because they die with greater 
difficulty ; because they are more irritable ; and, lastly, be- 
cause their muscles contract even several days after they are 
dead. 

" I had each of them bit by a viper, some in the thigh, 
others in the legs, back, head, &c. Some of them died in 
less than half an hour, others in an hour, and others again 
in two, three, hours, or somewhat more. There were some 
again that were not affected, whilst others that did not die 
became nevertheless swelled. There were likewise others 
amongst them that fell into a languishing state, their hind 
legs that had been bit continuing very weak, and even' 
paralytic. In some of them I contented myself with intro- 
ducing cautiously into a wound made with a lancet at the 
very instant, a drop of venom. These last lived longer than 
those I had had bit ; neither of them however escaped. I 
constantly took the precaution to prevent the venom I in- 
troduced into the wound being carried out by the blood that 
flowed from it. Some of these frogs swelled very much, 
others but little, and others not at all. The wounds of al- 
most all of them were inflamed more or less. There were 
some, however, that died very suddenly without the smallest 
mark of inflammation. A short time after these animals had 
either been bit, or wounded and venomed, the loss of their 
muscular force, as well as that of the motion of their ex- 



246 ON EPIDEMIC CHOLERA. 

tremities, was very evident. When they were set at liberty, 
they no longer leaped, but dragged their legs and bodies 
along with great difficulty, and could scarcely withdraw their 
thighs, when they were pricked with a needle, of the pain 
of which they seemed almost insensible : by degrees they 
became motionless and paralytic in every part of the body, 
and after continuing a very short time in this state, died. 

" I now opened the abdomen, and stimulated the nerves 
that pass through it in their way from the vertebrae to the 
thighs. I employed the strongest corrosives, but could ex- 
cite no motion nor tremulus in the lower extremities. I 
pricked the muscles with as little effect, and thrust a long 
pin into the spinal marrow, without producing any motion 
or trembling either of the muscles or limbs. In none of 
these parts, all of which had died at the same time, was 
there the smallest vestige of life. The nerves were no 
longer the instrument of motion. The muscles no longer 
contracted, and were no longer sensible to stimuli. The 
heart alone in some few of them continued to move languidly, 
and its auricles were swelled and blackened by the blood 
with which they were surcharged. This organ did not, how- 
ever, seem to have suffered much from the activity of the 
venom. It continued its motion, notwithstanding the entire 
death of the other parts, and renewed its vibrations on being 
strongly stimulated with needles. This motion and these 
oscillations were, however, but of short duration after the 
death of the animal. 

" Persons have been sometimes met with, who, having 
been bif by a viper, have remained paralytic in some parti- 
cular part of the body during life. A short time ago a 
woman in Tuscany, who had been bit in the little finger by 
a viper, became, after various other complaints, paralytic 
throughout the whole right side of her body, and could never 



ITS TREATMENT — LACHESIS. 247 

be cured. In a word, it is certain that all those who have 
met with this accident, complain soon after of an universal 
weakness. Their muscles refuse their office. They become 
dull and heavy, have no longer the free exercise either of 
body or mind, and fall insensibly into a kind of lethargy : 
so true it is, that this venom induces a palsy of the muscles, 
and robs them of that active property, called by the moderns 
animal irritability. In the continuation of this work, I shall 
show what opinion ought to be held of that system, and the 
changes I have made in it. 

" Thus, then, it appears that animals die of the bite of the 
viper, from their fibres losing that irritability, which is the 
grand principle, both of voluntary and involuntary motions 
in the animal economy/'* 

Dr. Mead gives the following symptoms as produced by 
the viper poison, — " Great faintness, a quick, low, and some- 
times interrupted pulse ; great sickness at the stomach, with 
bilious convulsive vomitings ; cold sweats, and sometimes 
pains about the navel/' -f- 

He recommends its use in ulcers and some forms of lepra, 
observing, " the patient ought to eat frequently of viper- 
jelly or broth, or rather, as the ancient manner was, to boil 
vipers and eat them like fish ; or (if this food will not go 
down, though really very good and delicious fare) to make 
use at least of wine in which dried vipers have been di- 
gested/^ 

The following cases are related in Russell's Indian Ser- 
pents : — 

" A daubish belonging to Cornet M'Gregor was bitten in 



* Treatise on the Venom of the Viper, &c, by Felix Fontana ; translated by 
Joseph Skinner. London, 1787. 

f A Mechanical Account of Poisons, by Richard Mead, M.D., 1747, p. 8. 
J Vide Pharmacop., London. 



248 ON EPIDEMIC CHOLERA. 

the toe by a snake which appeared to be a Cobra di capello. 
A few drops of blood issued from the part, and he was in- 
stantly sensible of pain. When he came to me about half 
an hour after the accident, the pain had advanced as high as 
the joint of his knee. I immediately prepared and gave him 
one of the snake- pills as directed, and that no part of the 
prescription should be omitted, the liver of a frog was ap- 
plied to the wound. In the course of ten minutes after 
giving the first pill, the pain had got to the top of his thigh, 
and became much more severe. I then gave two more pills, 
and ordered a bottle of Madeira to be warmed. Of this he 
drank about two cupfulls, but part only remained in his 
stomach. The patient now complained of severe pain in his 
belly, which on examination appeared to be tense and much 
swelled. A sense of tension or tightness spreading fast to- 
wards the breast, and respiration becoming extremely labo- 
rious, an attempt was made to make him take two more 
pills, but deglutition being impeded, a part of them only 
reached the stomach, and was immediately rejected. From 
this time the stricture of the oesophagus increased so much, 
that nothing could be forced down his throat ; he foamed at 
the mouth ; his eye stood staring and fixed ; his pulse and 
respiration became hardly perceptible ; in short, every vital 
motion seemed at a stand. I applied spirits of hartshorn 
to his mouth and nostrils, by which in a few minutes, a 
strong sneeze being excited, he began to breathe and said 
' better/ After he recovered a little, he told me he felt the 
pain descending retrograde, in the same track in which it 
had ariseri, and wished for sleep. He slept for half an hour, 
and on awaking vomited plentifully. He had now recovered 
his senses, and said he only felt a little pain in his toe, and 
in two hours he was able to walk home, but did not recover 
his fatigue for some days. 



ITS TREATMENT— CROTALUS HORRIDUS. 249 

" A Sepoy was bit by a long snake, supposed to be a 
Cobra di capello. His jaws became locked in less than a 
quarter of an hour, and very little sign of life remained. 
Four large punctures were observed in the ancle, to which 
eau de luce being applied, the man gave signs of sensibility 
by drawing up his legs. Two bottles of Madeira were then 
made warm, and the jaws being forced open so as to intro- 
duce a funnel, almost the whole of the wine in the course of 
half an hour was then poured down. The application of the 
eau de luce was continued for three hours, till the whole of 
the bottle was expended. The patient was now totally 
without any sense of feeling whatever, and had it not been 
for a gentle heave of his breast every two or three minutes, 
I should have thought him dead. 

" He remained in this torpid state for four hours, and 
then began to show signs of returning life. It was twelve 
hours more before he recovered his speech, and he continued 
many days in a very languid state. He is now one of the 
stoutest men in the first grenadier company." 

Wibmer* gives the following summary of the effects of 
snake poisons. After describing the local effects of the bite, 
he says that they are attended with inclination to vomit ; 
fainting fits ; small, irregular pulse ; thirst ; frequent car- 
dialgia ; vomiting of bilious fluid ; anguish ; oppression ; 
difficulty of breathing; dimness of sight ; loss of conscious- 
ness ; trembling of the limbs ; universal loss of power ; and 
death from a few minutes to several days after the reception 
of the poison. 

CROTALUS HORRIDUS. 

General symptoms. — Vertigo, with headach and nausea ; 
languor, and sudden decrease of the vital forces, with fever ; 

* Op. cit., vol. v. p. 37. 



250 ON EPIDEMIC CHOLERA. 

frequent fainting spells, with imperceptible pulse and incli- 
nation to vomit ; appears dead ; is motionless ; speechless, 
with trembling pulse ; paroxysmal trembling and convul- 
sions ; extreme restlessness. 

Skin. — Cold ; black spots over the whole body. 

Sleep. — Drowsiness, with cold skin. 

Fever. — Cold skin, with nausea ; cold hands and feet ; 
shuddering, with diarrhoea ; pulse 100 to ISO, with frequent 
fainting turns ; pulse feeble and quick, with fever and lan- 
guor ; pulse, first hard, then quick, then feeble and slow T ; 
tremulous, imperceptible pulse, with loss of motion and 
speech ; intermittent pulse ; constant fever with thirst ; 
bilious vomiting ; palpitation of the heart ; anguish ; quick 
and feeble pulse; languor, and rapid sinking of the vital 
forces. 

Moral symptoms. — Lowness of spirits ; indhTerence ; lan- 
guor ; melancholy, with sudden weakness ; headach ; sick- 
ness at the stomach ; diarrhoea ; melancholy ; sadness. 

Head. — Vertigo, with nausea ; dartings in the temples. 

Eyes. — Sunken eyes ; blue circle round eyes. 

Face. — Leaden-coloured face. 

Throat. — Difficult deglutition of saliva. 

Appetite. — Unquenchable burning thirst. 

Stomach. — Hiccough ; inclination to vomit, with cold skin ; 
violent vomiting after food ; vomiting green ; pain in pit of 
stomach ; pressure in the pit of stomach. 

Abdomen. — Burning in the hypochondria ; burning in the 
abdomen ; distention of the abdomen. 

Fceces. — Involuntary stools. 

Urine. — Retention of urine. 

Larynx. — Hoarseness, and weak, rough voice ; loss of 
voice. 

Chest. — Difficulty of breathing, with unquenchable thirst, 



ITS TREATMENT— LACHESIS. 251 

and tightness of the chest as if the lungs would not expand ; 
asthma, with anguish ; thirst, nausea, and diarrhoea ; oppres- 
sion of the chest. 

Arms. — Spasmodic, bruised pain ; trembling of the hands ; 
laming pains in the bones of the fingers. 

Legs. — Drawing pains ; spasmodic pain, with sensation, as 
if the flesh would be raised ; painful numbness in the toes, 
as after cramp. 

LACHESIS. 

General symptoms. — Heaviness in the limbs ; pain as if 
bruised ; painful uneasiness in the limbs ; tearing in the 
limbs ; paralysis ; languor, with feeling of prostration ; 
sudden falling as if struck by lightning, w T ith involuntary 
discharge of faeces, with vomiting ; frequent fainting fits ; 
trembling of the whole body ; sensation of internal trem- 
bling as if from anguish ; convulsions ; spasms. 

Sleep. — Drow r siness ; is unable to sleep on account of in- 
ternal uneasiness. 

Fever. — Chilliness ; coldness of the knees and calves ; 
small, weak, and irregular pulse ; intermittent and small 
pulse ; cold sweats. 

Moral symptoms. — Despondency ; restlessness ; loss of 
sense. 

Head. — Vertigo ; headach ; throbbings in the temples. 

Ears. — Roaring in the ears ; deafness. 

Face. — Sunken face, with expression of suffering ; livid, 
grey complexion ; blue rings round the eyes. 

Throat. — Soreness of the throat ; pain during deglutition ; 
dryness of the pharynx and oesophagus. 

Stomach. — Nausea ; vomiting ; vomiting of the ingesta ; 
spasmodic vomiting ; vomiting, with diarrhoea ; violent pain 
in the stomach, increased on pressure ; pressure in the pit 



252 ON EPIDEMIC CHOLERA. 

of the stomach ; violent spasms in the stomach ; burning in 
the stomach ; alternate coldness and heat in the stomach. 

Abdomen. — Burning in the abdomen ; tearing ; rumbling 
in the abdomen. 

Fceces. — Diarrhoea, with violent spasmodic colic ; with 
vomiting ; burning in the anus. 

Larynx. — Hoarseness, with roughness and burning in the 
throat ; failure of the voice. 

Chest. — Difficulty of breathing ; oppression of the chest ; 
constrictive sensation in the region of the heart ; pressure in 
the region of the heart ; palpitation of the heart. 

Trunk — Pain in the small of the back ; tearings in the back. 

Arms. — Pains in the arms ; creeping and pulling in the 
muscles ; cramp between the intercarpal bones ; tearing in 
the hands going up to shoulders. 

Legs. — Tearing in the hip ; drawing in the lower part of 
the limbs ; cramp in the calves and knees ; coldness of the 
calves and knees ; cramp in the anterior portion of the feet, 
with frequent tearings of the arms and lower limbs ; cold- 
ness of the feet ; spasmodic drawing up of the toes. 

Hydrocyanic acid we have seen give at least temporary 
relief in a few cases where there was great prostration and 
oppression of the chest. One poor woman, a sober, respect- 
able person, who had been ill for twelve hours when we 
saw her, and complained much of excessive uneasiness at 
the heart, exclaimed after a few doses of hydrocyanic acid, 
"God be thanked, my breast is getting benefit/' and for 
some time there was decided improvement both in her sen- 
sations and appearance. On the whole, however, we believe 
that the number of cases in which it is indicated, will not 
be found large ; perhaps the particular period suited for its 
administration is verv short. 



ITS TREATMENT — HYDROCYANIC ACID. 253 

The following case of poisoning quoted by Wibmer and 
Christison will illustrate the group of symptoms which are 
sometimes met with in cholera, and for which this medicine 
is adapted : " A thief took forty grains of the pure acid in 
dilution, and after staggering a few steps, he sunk without 
a groan to the ground. A physician who instantly saw him 
found the pulse gone and the breathing for some time im- 
perceptible. After a short time he made so forcible an ex- 
piration, that the ribs seemed drawn almost to the spine. 
The legs and arms then became cold, the eyes prominent, 
glistening, and quite insensible, and after one or two more 
convulsive expirations, he died/'* 

General symptoms. — Rapid languor and weakness of the 
limbs, particularly the thighs ; cramp in the back ; the 
limbs become insensible and stiff ; the beats of the heart be- 
come more and more slow, small, imperceptible ', until ap- 
parently extinct ; diminution of the animal heat 

Skin. — Dryness of the skin ; general paleness with a blue 
tinge. 

Fever. — Feeling of coldness within and without. 

Moral symptoms. — Despondency ; loss of consciousness. 

Head. — Vertigo ; headach. 

Eyes. — Eyes half open, distorted eyes ; pupils insensible 
to the light ; the lids are wide open ; immoveable lids ; ob- 
scuration of sight. 

Ears. — Roaring or buzzing ; hardness of hearing. 

Face. — Sunken face ; pale bluish face ; sallow and gray 
complexion. 

Mouth. — Cold feeling in the tongue ; loss of speech. 

Throat. — Heat in the pharynx and oesophagus. 

Appetite. — Violent thirst. 

* Hufeland's Journal, 1815, \ 113. 



254 ON EPIDEMIC CHOLERA. 

Stomach. — Disposition to vomit ; vomiting of a black 
fluid ; cold feeling in the stomach ; pressing in the pit of the 
stomach, with great oppression. 

Abdomen. — Coldness in the abdomen alternating with 
burning ; rumbling in the abdomen. 

Fceces. — Involuntary stool. 

Urine. — Retention of urine. 

Chest. — Rattling, moaning, slow breathing; feeling of 
suffocation ; pain and pressure in the region of the heart ; 
irregularity of the motions of the heart ; feeble beating of 
the heart 

We may add the symptoms of Laurocerasus — a medicine 
we have never had occasion to administer. 

General symptoms. — Great languor of the whole body, par- 
ticularly of the lower extremities ; excessive weakness and 
prostration ; sudden fainting fits ; convulsions ; spasms of 
the back ; falls down immediately, and is lifeless in five 
minutes ; without pulse or breath ; with icy coldness of the 
extremities, and paralysis of all the muscles. 

Fever. — Coldness of the extremities ; the body feels much 
colder than natural ; chilliness of the whole body, with pains 
in the back ; pulse (as well as the heart) scarcely percep- 
tible, slow ; pulse small and slow, also contracted ; pulse 
feeble and slow. *■ 

Moral symptoms. — Insensibility and complete loss of sen- 
sation. 

Head. — Vertigo with stupefaction ; vertigo on raising the 
head ; aching in the head ; beating in the head. 

Eyes. — Glaring ; distorted ; eyes half open. 

Ears. — Buzzing in the ears ; hardness of hearing. 

Face. — Sunken countenance; livid grey-yellow complexion ; 
pale appearance. 



ITS TREATMENT — CICUTA V1R0SA. 255 

Mouth. — Loss of speech. 

Throat — Burning in the throat ; deglutition is impeded. 

Appetite. — Violent thirst, with dry mouth. 

Stomach. — Hiccough ; also the whole day, nausea ; vomit- 
ing and loathing ; vomiting of the ingesta, and nausea ; pain 
in the stomach ; burning in the stomach and abdomen ; 
pressure in the stomach. 

Abdomen. — Pinching in the abdomen ; burning in the 
abdomen ; distention of the abdomen. 

Fceces. — Discharge of fseces without being conscious of it ; 
burning at the anus. 

Urine. — Retention of urine for four days ; diminished se- 
cretion of urine. 

Chest. — Slow, feeble, almost imperceptible breathing ; 
tightness of the chest, with pressure in the region of the 
heart ; oppression of the chest, with difficulty of breathing ; 
pressure, as from a load on the chest ; palpitation of the 
heart. 

Cicuta virosa, or water-hemlock, is indicated in cases where 
the respiratory apparatus acts convulsively, as for example 
where there is violent hiccough or loud belching. A dose of 
it to- the amount of a drop of the second or third dilution 
may be given to relieve this very painful and troublesome 
symptom. We have seen it of decided advantage in such 
cases. 

Wepfer* has related the particulars of the poisoning of 
several children by the root of this plant. In one of them, 
Jacob Mader by name, who was six years old, the counte- 
nance assumed a dreadful expression, his teeth became 
clenched, and he rolled his eyes about. " Hiccough was fre- 
quent, and he seemed to wish to vomit, but could not." 

* Hist. Cicut. Aquat., Lugd. Bat., 1733, p. 6. 



256 ON EPIDEMIC CHOLEKA. 

There were also violent convulsions of the limbs. In another 
of the children, Methias Gref, eight years old, a pulsating 
tumour was observed at the precordial region, which beat 
upon the diaphragm, attended with violent hiccough. 

General symptoms. — Crampy stiffness of the whole body, 
with coldness of the same ; the most violent tonic spasms, so 
that neither the curved limbs could be straightened, nor 
the straight limbs curved ; the limbs are tossed to and fro ; 
general convulsions ; trembling in the upper and lower limbs ; 
insensibility. 

Fever. — Coldness over the lower limbs, afterwards the 
arms ; they want to sit near the stove. 

Head. — Vertigo ; hammering pain in forehead. 

Ears. — Roaring in the ears ; deafness. 

Face. — Deadly paleness of the face, also with coldness of 
the face and cold hands ; grinding of the teeth. 

Appetite. — Oreat thirst. 

Stomach. — Hiccough, resounding at a distance ; nausea ; 
vomiting ; burning and scraping sensation from the throat 
to the region of the stomach ; burning pressure at the 
stomach. 

Abdomen. — Rumbling in the abdomen ; heat in the abdo- 
men ; horrid colic. 

Fceces. — Diarrhoea. 

Urine. — Retention of urine ; frequent desire to urinate. 

Larynx. — Hoarseness. 

Chest. — Tightness in the chest, she is scarcely able to breathe 
the whole day ; want of breath. 

Trunk. — Tonic spasms of the cervical muscles. 

Arms. — Arms are cold and stiff ; deadness (numbness, cold- 
ness) of the fingers ; stitches in the arms. 

Legs. — Painful stiffness and rigidity in the muscles of the 
lower limbs ; tearing pains in the thighs. 



ITS TREATMENT— TOBACCO. 257 

Tobacco we have little experience of in cholera ; but we 
should feel disposed to try it in certain cases, if we again had 
the opportunity. The cases for which it would best answer 
are those attended with much depression, vomiting, eructa- 
tion, and obstinate dysuria, or suppression of urine, along 
with pains in the bowels and cramps, and oppression of the 
chest. 

Grant* relates how a peasant washed himself and his wife 
with an infusion of tobacco one evening at nine o'clock, and 
that at ten o'clock they became giddy and as if drunken, that 
afterwards the man was attacked with violent eructation 
and vomiting, and his wife with diarrhoea and gripes. In 
the morning the physician who saw them found them both 
suffering from insatiable thirst, quick pulse, dry and hot skin, 
and the man from violent tormina, inclination to vomit, 
cramps in the hand and arms, and constriction of the chest ; 
the woman from anxiety, nausea, and oppressed, hurried 
respiration. 

General symptoms. — Great weariness ; languor ; and de- 
bility of the extremities and trembling of the hands and 
feet ; general debility and coldness ; trembling of the hands, 
after which he lies as if paralyzed, with stupor, headach ; 
general paleness, colic, difficult breathing ; lastly coma, pulse 
68 ; death, vacillation, trembling, general weariness of the 
muscles ; spasmodic contraction of the muscles ; spasms ; 
general insensibility ; relaxation ; fainting fits ; trembling ; 
loss of consciousness ; violent involuntary contraction of 
all the muscles, with expressions of the most horrid pain ; 
he constantly put his hand on the abdomen and pressed 
with great violence ; spasms and convulsion ; death-like 
paleness. 

Sleep. — Restless sleep, with coldness. 

* Duncan's Med. Comment., vol. i. p. 327. 
R 



258 ON EPIDEMIC CHOLERA. 

Fever. — Coldness of the extremities ; coldness and shud- 
dering of the whole body ; warmth of the body, with icy 
cold hands ; profuse sweat, with coldness of the extremi- 
ties ; icy coldness of the legs, with heat of the body ; profuse 
sweat about the head and on the chest ; cold sweat ; cold 
sweat on the hands; viscid, cold sweat; coldness of the 
limbs and great languor, with slow intermittent pulse; 
small, slow pulse ; small, languid pulse, with cold skin, 
and viscid sweat ; hard, quick pulse ; the pulse is almost 
imperceptible, very small, intermittent, exceedingly slow, 
45 beats. 

Moral symptoms. — Muttering ; delirium ; oppressive 
anxiety or insensibility ; great restlessness, anguish, and 
oppressive apprehensiveness. 

Head. — Vertigo ; violent headach. 

Eyes. — Obscuration of sight. 

Ears. — Roaring in the ears. 

Face. — The face looks bluish and contracted ; death-like 
paleness. 

Mouth. — The patient was not able to talk, except in a low 
tone, and with intermissions. 

Throat. — The throat is so dry that he is scarcely able to 
swallow ; burning in the throat and mouth ; spasm of the 
pharynx. 

Stomach. — Hiccough ; spasmodic hiccough ; nausea ; vo- 
miting; spasmodic vomiting; singultus ; vomiting, with sweat 
or with diarrhoea, and pinching in the abdomen ; violent vo- 
miting, diarrhoea, anguish, debility, stupefaction, and sweat ; 
vomiting of a quantity of liquid in a long stream ; vomiting 
of mere water ; vomiting as soon as he begins to move ; 
violent vomiting, after which retching remained ; pressure 
in the stomach ; burning in the stomach ; feeling of cold- 
ness in the stomach, with nausea and disposition to vomit ; 



ITS TREATMENT— TARTARUS EMETICUS. 259 

feeling of coldness In the stomach and along the vertebral 
column. 

Abdomen. — Violent contractions of the abdominal muscles; 
violent aching pains in the hypogastrium, with nausea and 
disposition to vomit, or with chilliness of the whole body ; 
horrible pains in the abdomen ; sensation of violent burning, 
obliging him to shriek ; heat in the intestinal canal ; violent 
colic, with vertigo, headach, nausea, contraction of the abdo- 
men, small pulse, cold and damp skin, rumbling in the ab- 
domen, with feeling of coldness in the whole body. 

Fceces. — Diarrhoea ; tenesmus, and violent burning pain 
in the anus during stool ; discharge of a continuous stream 
of green, watery liquid in large quantity. 

Larynx. — Roughness of voice. 

Chest. — Great difficulty of breathing ; paroxysms of suffo- 
cation ; oppression of the chest and anguish ; pressure and 
stitches in the chest ; irregular, generally slow beating of the 
heart ; pressure on the sternum as from something heavy. 

Back. — Contractive pain in the small of the back. 

Extremities. — Coldness and trembling of the limbs; spasms 
of the limbs. 

A?*ms. — Cramps in the hands and arms ; spasmodic con- 
tractions in the hands and arms. 

Legs. — Violent pains in the legs ; cramp from the toes to 
the knee. 

Tartarus emeticus is a medicine we have occasionally em- 
ployed, and with advantage in cases of long-continued nausea 
and vomiting and general depression, without the actual 
state of collapse. 

General symptoms. — Weariness in every part of the body ; 
complete insensibility ; spasmodic movements of the hands 
and arms ; violent alvine spasms, with loss of consciousness ; 



260 ON EPIDEMIC CHOLERA. 

fainting fits ; feeling of coldness in the pit of the stomach ; 
great laziness and weariness in the limbs ; relaxation of the 
whole body ; great prostration and languor ; exhaustion ; 
collapse of pulse ; loss of speech ; marble coldness of the 
body. 

Shin, — Pale skin ; cold, clammy skin, particularly about 
the head and. extremities ; insensibility of the skin. 

Sleep. — Drowsiness ; restless sleep. 

Fever. — General uneasiness, alternating with nausea ; 
chilliness about the whole body, with tremor ; cold as marble 
after the alvine spasms, with collapse of pulse ; cold, clammy 
sweat ; quick, feeble, tremulous pulse ; pulse weaker and 
slower than usual ; slow pulse ; small, contracted, accelerated 
pulse ; suppressed, irregular, imperceptible pulse ; collapse 
of pulse. 

Moral symptoms. — Loss of sense ; dulness and dizziness ; 
apprehensiveness and restlessness ; great anxiety ; anguish, 
with cold sweat ; tendency to start. 

Head. — Vertigo ; headach. 

Face. — Blue margins around the eyes ; blue lips ; pointed 
nose ; wretched look ; and great paleness. 

Throat. — Burning heat in the throat ; difficulty of swal- 
lowing. 

Mouth. — Dryness of the mouth ; the tongue is moist and 
clean, or grey, and coated white. 

Stomach. — Nausea, and disposition to vomit ; constant 
nausea, vomiting, and diarrhoea ; hiccough ; ineffectual retch- 
ing ; frequent, violent retching, with accumulation of water 
in the mouth ; violent vomiting ; spasmodic vomiting ; the 
vomiting is followed by great languor ; drowsy and weary 
feeling ; loathing ; desire for cooling things ; pale, sunken 
face, and dry swimming eyes ; burning in the region of the 
stomach ; excessive pain in the stomach. 



ITS TREATMENT — CARBO VEGETABILIS. 261 

Abdomen. — The abdomen sensitive to contact ; violent 
pressure in the abdomen. 

Fasces. — Uninterrupted watery evacuations ; involuntary 
diarrhceic stool ; diarrhoea and vomiting ; tenesmus ; bloody 
stools ; burning at the anus after stool. 

Larynx. — Feeble voice; aphonia. 

Chest — Short, difficult breathing ; the inspirations are 
less frequent ; unusual oppression of the chest ; palpitation 
of the heart. 

Arms. — Violent tearing, jerking, and drawing in the arm ; 
cold hands, and icy coldness of the tips of the fingers. 

Legs. — Heaviness in the loins ; lancinating, tearing pain 
in the hips, thighs, and legs ; extremely painful cramps in 
the thighs and calves ; cold feet. 

Garbo Vegetabilis is said to have been useful in cases of 
great collapse, but for our part we cannot say we have any 
great faith in its efficacy in such a disease as cholera. We 
have tried it occasionally, but without obtaining any results. 

General symptoms. — Drawing pain in the limbs in almost 
every part of the body ; great anguish ; tremulousness of the 
body, attended with great failing of strength ; languor, espe- 
cially in the lower extremities ; attacks of sudden weakness 
like fainting ; vertigo ; loss of consciousness for some hours. 

Sleep. — Drowsy, but unable to fall asleep. 

Fever. — Chilliness and coldness of the body; chilliness 
with thirst, sometimes only internal ; pulse frequent, feeble, 
depressed ; great disposition to sweat. 

Moral symptoms. — Anguish ; tendency to start. 

Head. — Vertigo; violent aching; pulsating pain in the 
forehead ; buzzing in the head. 

Face. — Complexion becomes grey-yellow ; great paleness 
of the face. 



262 ON EPIDEMIC CHOLERA. 

Throat — Soreness in the throat ; coldness in the throat. 

Stomach. — Nausea ; weight in the stomach ; burning sen- 
sation in the stomach. 

Abdomen. — Every piece of clothing presses upon the 
hypochondria, and seems intolerable to him; disagreeable 
pressure in the abdomen. 

Fceces. — Burning in the rectum after stool. 

Urine. — Greatly diminished emission of urine ; desire to 
urinate. 

Larynx. — Hoarseness ; loss of voice. 

Chest — Tightness of the chest and short breathing ; spas- 
modic oppression and contraction of the chest ; cold breath ; 
coldness in the throat, mouth, and teeth ; stitches through 
the chest; violent burning in the chest almost uninter- 
ruptedly ; burning in the region of the heart ; palpitation 
of the heart. 

Trunk. — Tearing and pressure in the back ; tearing in the 
cervical muscles. 

Arms. — Cramp in the arms ; drawing pains in the arms ; 
spasmodic contraction of the hand ; icy cold hands ; dispo- 
sition of the hands to become numb. 

Legs. — Tearing pain in the lower extremities ; violent 
cramp in the leg, and especially the sole of the foot. 

Oxalic Acid ought to be useful in the disease, if we are right 
in regard to its pathology ; for it seems to cause very much 
the same round of symptoms. When the dose of the substance 
is large, it seems to cause palsy of the heart ; when smaller, 
it produces violent tetanus and spasms of the respiratory 
muscles, and when still less, it produces pure narcotism. It 
seems to cause a morbid state of the blood, for leeches ap- 
plied to the surface of a patient poisoned by it, in a few 
minutes fell off hard and dead. It is possible this may have 



ITS TREATMENT — OXALIC ACID. 263 

been from the actual presence of some of the poison in the 
blood, but more probably from the disorganization of the 
blood itself, which remains fluid after death by poisoning 
with oxalic acid. The signs of depressed circulation are also 
very striking. In general the pulse fails altogether ; it is 
always very feeble, and the skin is cold and clammy.* 

We should advise it to be given in cases characterized by 
sudden collapse. We have tried it occasionally, but with- 
out obtaining any results from which an opinion could be 
formed. 

General symptoms. — Extreme lassitude of the body ; 

tremor of the limbs ; loss of consciousness for eight hours ; 

convulsions, with one or two deep inspirations before death. 

Sleep. — Slept very little ; when he did, starting and waking 

from fright. 

Fever. — Clammy perspiration ; his hands, feet, and face 
were cold, and covered with a cold perspiration ; pulse in 
every case became imperceptible, and even in those who re- 
covered it could not be felt for several hours ; this state of 
the pulse was accompanied with deadly coldness, clammy 
sweats, sometimes lividity of the nails and fingers; extreme 
feebleness of the pulse ; pulse small, tremulous, intermittent 
Head. — Vertigo and giddiness. 
Mouth. — The tongue felt rather cold than warm. 
Appetite. — Unusual thirst ; violent thirst. 
Stomach. — Hiccough, which continues for some time ; nau- 
sea ; vomiting ; sensation of grasping in the stomach ; burn- 
ing pain in the stomach, and generally also in the throat ; 
pressure in the stomach ; severe pain in the stomach ; ex- 
cruciating pain in the stomach. 

Abdomen. — Pain and aching about the navel ; pain in the 
abdomen ; borborygmus ; a sticking pain in hypochondrium. 
* Christison on Poisons, p. 222. 



264 ON EPIDEMIC CHOLERA. 

Faeces. — Severe pain in the bowels, and frequent inclina- 
tion to stool; constant involuntary discharge of fluid faeces, 
occasionally mixed with blood. 

Chest. — Difficulty of breathing ; oppression of the whole 
chest towards the right side. 

Trunk. — Acute pain in the back, extending down the 
thighs. 

Extremities. — Lividity of the nails and fingers ; uneasi- 
ness and stiffness in the limbs ; lividity, coldness, and al- 
most complete loss of power of motion in the legs. 

Jatropha Ourcas, or physic-nut, is said to have been used 
with advantage by the Russian physicians in the recent 
cholera epidemic. We have tried it once or twice, but the 
results were purely negative. We know but little of the 
effects of this substance. Percival says,* that a man who had 
chewed twenty seeds of the plant became affected with vio- 
lent vomiting and purging, loss of power, and spasms of 
various parts ; and Dr. Christisonf found fifteen drops of the 
oil produce as much effect as an ounce of castor oil. 

Digestive apparatus. — Loathing nausea ; disagreeable burn- 
ing sensation in the stomach and oesophagus ; violent vomit- 
ing and purging, with rush of blood to the head ; anxiety, 
with burning at the stomach ; easy vomiting of a large quan- 
tity of watery substances resembling the white of an egg, 
attended with diarrhoea, (as if the contents of the rectum 
would gush out like a torrent,) accompanied by anguish ; 
coldness of the body; viscid sweat ; violent cramp pains in the 
lower limbs, to such an extent that the calves look flat like 
splints ; violent, excessive evacuations upwards and down- 
wards, attended with complete prostration, spasms, and 
death ; increased evacuations. 

* Medical Trans., vol. v. p. 96. f °P- cit » P- 69L 



ITS TREATMENT— PHOSPHORUS. . 265 

Extremities. — Rheumatic drawing in left foot, extending 
to the ball of the big toe. 

Phosphorus and Phosphoric Acid are valuable medicines, 
both in the painless diarrhoea which precedes cholera, and 
also in the latter stage of the disease before it passes into 
the typhoid state. The most prominent symptom at this 
period is frequently great oppression of the breathing ; the 
respiration is heaving, and the patient complains of the 
intolerable load upon the chest. We have seen phosphorus 
give relief, although temporary, in this painful condition ; 
and we should recommend it to be given in pretty strong 
and repeated doses. 

PHOSPHORUS. 

General symptoms. — Deadness of the hands and feet ; rigi- 
dity of the hands, feet, and nose ; a sort of insensibility of 
the whole body; coldness, want of warmth in the whole 
body ; icy coldness of the hands and feet the whole day ; 
languid feeling as of being bruised ; general, sudden, exces- 
sive weakness ; fainting ; convulsions. 

Sleep. — Drowsiness, without being able to sleep ; waking 
with a start. 

Fever. — Coldness of the whole body, as if deficient in ani- 
mal heat ; coldness of the limbs ; shuddering of the whole 
body ; chilliness ; pulse quick and faint. 

Moral symptoms. — Anguish ; anxiety ; anxious about her 
illness. 

Head. — Vertigo ; headach ; beating pain in the temples. 

Face. — Pale face ; sunken eyes, with blue margins ; sunken 
livid countenance, with deep hollow eyes, and blue margins 
around. 

Mouth. — Dry tongue ; furred tongue ; bleeding tongue. 



266 . ON EPIDEMIC CHOLERA. 

Throat — Burning in the pharynx. 

Appetite, — Much thirst for water. 

Stomach — Frequent hiccough ; nausea, with great thirst ; 
vomiting several times ; empty vomiting ; violent vomiting ; 
vomiting, accompanied with excessive weakness ; small, 
quick pulse, and pains in the abdomen ; continual vomit- 
ing ; vomiting of the ingesta ; sour vomiting ; green, black- 
ish vomiting ; pain in the stomach — increased on pressure ; 
continual pressure in the pit of the stomach ; cramp in the 
stomach ; violent burning heat in the stomach ; burning in 
the stomach also extending to the throat and bowels ; vio- 
lent burning in the stomach, with violent thirst ; anguish, 
and convulsions of the face ; cold limbs ; weak pulse ; feel- 
ing of coldness in the stomach, sometimes alternating with 
heat. 

Abdomen. — Violent pain in the whole abdomen ; pressure 
in the abdomen ; feeling of coldness in the abdomen ; burn- 
ing and pressure in the abdomen. 

Fceces. — Diarrhoea, with tenesmus of the rectum ; green 
and black stools ; burning at the rectum. 
* Chest. — Difficulty of breathing ; frequent oppression of the 
chest ; sensation as if the chest were oppressed by a load ; 
pressing oppression ; crampy contraction of the whole chest ; 
severe stitches in the chest ; palpitation of the heart. 

Trunk. — Violent stitches in the muscles of the back. 

Arms. — Tearing pains in the arms ; cold hands ; cramp- 
like drawing in the hands. 

Legs. — Restlessness in the limbs; tearing pains in the 
thighs ; cramp in the calf. 

PHOSPHORIC ACID. 

Mouth. — Dryness of the mouth. 
Appetite. — Violent thirst. 



ITS TREATMENT — MERCURIUS SOLtTBILIS. 267 

Stomach. — Nausea ; vomiting of ingesta ; oppression of 
the stomach ; coldness of the stomach ; burning under the 
pit of the stomach. 

Abdomen. — Crampy pain in the abdomen ; crampy sensa- 
tion, with pressure in the umbilical region. 

Faeces. — Frequent desire for stool ; stool loose, and fre- 
quent diarrhoea ; white, grey diarrhoea ; involuntary stool. 

Urine. — Retention of urine ; desire to urinate, with scanty 
emission. 

Chest. — Breathing heavy and oppressed ; oppressive anxiety 
in the chest ; constrictive pain in the chest ; stitches in the 
tfhest ; crampy pressure in the chest. 

Trunk. — Violent stitch in the small of the back. 

Arms. — Paralytic, crampy pressure in the upper arm ; the 
fingers go to sleep, become cold, yellow, and shrivelled, the 
pulse being slow, small, and scarcely perceptible. 

Legs. — Crampy pains in the thighs ; cramp-like pains in 
the calves and feet. 

Mercurius solubilis and corrosivus, as might be expected, 
are most useful when there is a complication with cholera 
and dysentery, or, at all events, when the stools are bloody 
and attended with much pain. This medicine may be given 
frequently, and answers well in alternation with aconite. It 
is better suited for the milder cases of cholera than for its 
more malignant forms. 

MERCURIUS SOLUBILIS. 

General symptoms. — Cramp in several parts during mo- 
tion ; restlessness ; he is unable to remain quiet ; languor ; 
excessive weakness. 

Fever. — Violent thirst ; continual coldness of the hands 
and feet ; chilling internal coldness ; chilliness all over, with 



268 ON EPIDEMIC CHOLERA. 

ice-cold hands ; accelerated pulse ; feeble, slow, trembling 
pulse. 

Moral symptoms. — Inexpressible feeling of some internal, 
insupportable illness, during which he remains silent, and 
does not wish to leave his bed ; anguish, with restlessness ; 
attack of fear ; great tendency to start. 

Head. — Vertigo ; headach. 

Face. — White, clay-coloured face, with attenuated, sunken 
features, and dim, gloomy eyes ; blue-red margins round the 
eyes. 

Mouth. — Tongue coated ; complete loss of speech. 

Throat. — Difficulty of swallowing ; pain in the throat as 
if too dry ; burning in the throat. 

Stomach. — Frequent hiccough ; nausea ; inclination to 
vomit, accompanied by vertigo ; violent vomiting ; pressure 
in the pit of the stomach ; burning pain in the pit of the 
stomach; great painfulness of the pit and region of the 
stomach, particularly to touch. 

Abdomen. — Pressure in the abdomen ; contraction ; pinch- 
ing in the abdomen. 

Fceces. — Ineffectual desire for stool, with tenesmus ; con- 
stant desire for stool, passing very little at a time ; several 
scanty, burning, smarting stools through the day ; discharges . 
of bloody mucus, accompanied with colic and tenesmus ; 
loose feces, lined with mucus and blood ; white-grey stool ; 
diarrhoeic stool, streaked with blood ; bloody stools, with 
painful acrid sensation at the anus ; discharges of dark-green 
mucus ; green, slimy, acrid stools, corroding the anus ; burn- 
ing diarrhoea ; burning pain at the anus, with loose stools. 

Urine. — Constant desire to urinate, but no urine is passed. 

Chest. — Oppression in the region of the sternum ; burning 
sensation in the chest ; cramp pain and tension in the left 
side. 



ITS TREATMENT— MERCIIRIUS CORROSIVUS. 269 

Trunk. — Tearing pains in the back. 

Arms. — Sticking cramp pain in the muscles of the arm ; 
painful cramp of the fingers and hands. 

Legs. — Tearing pain in the thighs ; coldness of the thighs; 
cramp in the lower part of the thigh ; painful cramp in the 
calf ; cramp-like contraction of the toes. 

MERCURIUS CORROSIVUS. 

General symptoms. — General debility ; fainting fits ; toss- 
ing to and fro ; trembling of the limbs ; spasms in all the 
limbs ; constant spasms in all the limbs ; tetanic spasms ; 
convulsions ; general insensibility. 

Skin. — Cold skin, covered with sweat. 

Sleep. — Violent starting when on the point of falling 
asleep, with violent concussion of the whole body. 

Fever. — Burning heat, as if he was roasted ; cold sweats ; 
regular, small, tight pulse ; irregular, small, contracted pulse ; 
frequent, small, quick, feeble, tremulous pulse. 

Moral symptoms. — Indescribable anguish ; oppressive an- 
xiety ; melancholy. 

Head. — Vertigo. 

Eyes. — Dim eyes, surrounded by blue margins. 

Face. — Bluish paleness of the face ; pale face ; distortion 
of the face. 

Mouth. — Tongue with little moisture ; yellow. 

Throat. — Roughness of the throat, rendering speech diffi- 
cult ; burning in the fauces. 

Appetite. — Unquenchable thirst ; burning thirst. 

Stomach. — Nausea; vomiting; violent attacks of vomit- 
ing in frequent succession ; continued vomiting ; habitual 
vomiting ; vomiting of a bloody fluid after violent retching ; 
excessive sensitiveness of the epigastrium to contact ; heat 
in the stomach reaching up to the fauces; pains in the 



270 ON EPIDEMIC CHOLERA. 

stomach ; violent pains in the epigastrium, increasing very 
rapidly, and becoming intolerable ; gnawing and burning 
pains in the stomach, spreading over the whole abdomen, 
and very sensitive to the least touch; excessively burn- 
ing pains in the stomach and abdomen; burning in the 
stomach. 

Abdomen. — : Violent pains in the bowels ; burning in the 
abdomen. 

Faeces. — Diarrhoea; evacuation, consisting of very thin 
faeces ; evacuation of feces mixed with mucus and coagu- 
lated blood ; diarrhoea, accompanied with violent pains in 
the abdomen, and tenesmus ; frequent attacks of bloody 
diarrhoea ; liquid stools, witli tenesmus ; violent, bloody 
diarrhoea, with tenesmus ; bloody evacuations. 

Urine. — Suppression of urine; scanty, red urine passed 
with difficulty. 

Larynx. — Hoarseness ; aphonia. 

Chest. — Difficult breathing ; shortness of breath ; oppres- 
sion in the chest ; excessive dyspnoea ; pains in the chest. 

Arms. — Coldness in the hands. 

Legs: — Pains in the loins and knees, afterwards in the 
other limbs ; icy cold feet. 

Ipecacuanha is very useful in the milder cases of cholera, 
especially when the patients are young. We have seen it 
apparently arrest the disease in children, but it is of little 
use in the severer cases. 

General symptoms. — Rigid stretching of the whole body. 

Sleep. — Drowsiness ; starting during sleep. 

Fever. — Chilliness ; his body feels cold ; hands and feet 
icy cold, and dropping with cold sweat. 

Head. — Vertigo. 

Eyes. — Red, inflamed eyes. 



ITS TREATMENT— CHAM0M1LLA. 271 

Face. — Pale face, with blue margins around the eyes, and 
great weakness as after a long and severe illness. 

Stomach. — Nausea ; nausea, with heaviness in the abdo- 
men ; vomiting of ingesta ; vomiting of large quantities of 
mucus ; vomiting green mucus ; excessive sick feeling in the 
region of the stomach ; horrid pains in the stomach. 

Abdomen. — Uneasiness in the abdomen ; griping, pinch- 
ing in the abdomen, as if one were grasping with the hands 
the intestines ; cutting pain around the umbilicus. 

Fceces. — Green stools ; diarrhoeic stools ; foetid stools ; 
bloody stools. 

Urine. — Scanty emission, with frequent desire to urinate. 

Chest. — Contraction of the chest, with short, panting 
breathing ; palpitation of the heart. 

Extremities. — Cramp pain during motion between the 
scapula? ; weariness of the lower limbs ; twitching and creep- 
ing in the gastrocnemic muscles, as when a limb has gone to 
sleep. 

Chamomilla. — The same remark applies to this medicine 
as to the preceding one. It is only suited for the milder 
cases, and is particularly well adapted for children. 

General symptoms. — Weakness of the hands and feet ; 
heaviness in all the limbs; general stiffness for a short 
period ; fainting fits ; convulsive and epileptic fits. 

Sleep. — Starting in the sleep. 

Fever. — Chilliness ; internal heat, with shuddering. 

Moral symptoms. — Repeated attacks of anguish ; exces- 
sive restlessness; anxious agonizing tossing about, with 
tearing pains in the abdomen ; crying and howling ; he in- 
clines to start. 

Head. — Vertigo ; when rising, headach ; tearing pain in 
the forehead. 



272 ON EPIDEMIC CHOLERA. 

Eyes. — Obscuration of sight. 

Ears. — Humming in the ears and dulness of hearing. 

Face. — Frequent changes of colour ; convulsive movements 
and twitchings of the facial muscles and lips. 

Mouth. — Putrid smell from the mouth ; dry mouth and 
tongue with thirst ; red tongue. 

Throat — Pain in the throat increased by movement and 
deglutition. 

Appetite. — Unquenchable thirst and dry tongue. 

Stomach. — Frequent hiccough ; inclination to vomit ; in- 
clination to vomit as if one would faint ; vomiting of ingesta ; 
oppression at the stomach. 

Abdomen. — Aching pain above the umbilicus ; flatulence ; 
compressive pain in the abdomen. 

Fceces. — Diarrhoea. 

Urine. — Urine is hot. 

Chest — Oppression in the chest ; crampy pain in the chest. 

Trunk. — Stinging pain in the back. 

Arms. — Hands are cold ; cold hands, with cold sweat in 
the palms of the hands. 

Z#7&— Drawing pain in the limbs ; cramps in the calves ; 
cramp-like contraction in the toes, with tearing pains in the 
limbs. 

We have now finished the list of medicines which have 
been found useful in the second and third stage of cholera, 
and we should proceed to speak of the treatment of the con- 
secutive fever. Before doing so, however, we may make a 
few remarks about the repetition of the dose, and the length 
of time for which a remedy should be persevered in. 

It is quite obvious that different medicines require a 
different length of time for manifesting their effects. A 
medicine given to cure a spasm may be useful in a few 



ITS TREATMENT— CHAMOMILL A. 273 

minutes, but not so a medicine which is suited to counteract 
a morbid state of the blood. Hence what we should call 
the intercurrent remedies given to relieve some special group 
of symptoms, should not be so long continued as the radical 
remedies, unless they mitigate the symptoms for which they 
are given. The frequency of the repetition of the dose must 
depend much upon circumstances. As a general rule we 
repeat it very frequently every ten minutes or quarter of an 
hour at first, and gradually prolong the intervals. But we 
do not think it is possible to lay down any rules upon the 
subject, and much must be left to the tact and judgment of 
the practitioner ; for there are no two cases altogether alike. 
In regard to the treatment of the typhus fever which 
sometimes succeeds cholera, we are thankful to say we 
have had very little experience, and we do not believe that 
when the disease is treated according to the homoeopathic 
system, that it will be found at all a frequent consequence. 
The medicines most recommended in it are Rhus toxicoden- 
dron, Bryonia, Belladonna, Aconite, Arsenicum, we should 
also add Helleborus niger, Cantharides, and Lachesis. But 
we believe that, like typhus fever, it will be found a very 
intractable complaint, and that it is very difficult to form 
a decided opinion of the efficacy of any particular medi- 
cines. The good which remedies effect is necessarily slow in 
its operation, and it is hard to say how much is due to the 
natural course of the disease towards a favourable termina- 
tion, and how much to the curative action of the medicines 
we administer. It may possibly be necessary to give sti- 
mulants in this stage, such as brandy and water or wine. 
This must be left to the discretion of the practitioner. 



274 ON EPIDEMIC CHOLERA 



CHAPTER VI. 

IN EDINBURGH. 

All that now remains for us to do is to give an account of 
the progress of the disease in Edinburgh, the circumstances 
by which it was attended, and the measures taken by the 
local authorities and the Homoeopathic body to meet the 
emergency. A rumour prevailed about the end of September 
of some cases of true Asiatic cholera having occurred in 
Leith, but it was not till the 2d of October 1848, that an 
official report of the existence of the disease in this city was 
made to the civic authorities, and brought under the notice 
of the Town Council. The fact was formally announced in 
the Newspapers, and a sort of Board of Health was formed, 
of which the Lord Provost was a member. Nothing more 
was done by them at that time. We now thought it was 
time .to take measures for encountering the disease, and ac- 
cordingly at a meeting of the Committee of the Homoeopathic 
Dispensary, it was resolved that we should open that Insti- 
tution day and night, and that a medical officer should be 
continually in attendance, to receive intimation of any per- 
son ill of cholera who wished to be visited by us. 

It was obviously of no use opening our doors, and sitting 
at the Dispensary, unless the poor people were made aware 
of the fact ; accordingly, hand-bills were posted about the 
town, especially about those places where the disease was 
reported to have appeared, stating that medical aid could be 
obtained by any person attacked by cholera, by sending to 
the Homoeopathic Dispensary. This was done upon Satur- 



IN EDINBURGH. 275 

day night. On the following day we were sent for in the 
afternoon to see our first case. The poor woman was far 
gone when we arrived, and the persons about her told us 
that they did not know where to go for assistance, until a 
neighbour, who had read one of our hand-bills, informed 
them of our being ready to attend at all hours, and then they 
came for us. Had it not been for us she would have died 
without medical attendance altogether — like a dog — unless, 
indeed, the appearance of the medical officer attached to the 
Police Office, within two hours of her death, could be called 
medical attendance. He came to certify the case — to be sure 
that it was really cholera, that he might report it to the Town 
Council ; and we suppose he did his duty. On the follow- 
ing morning we were rather surprised to find all our hand- 
bills torn down, and to be told it was done by order of the 
Lord Provost, and that the man employed by us to put them 
up had been taken into custody. The Secretary was imme- 
diately requested to communicate with his Lordship, and 
ascertain whether such was the fact, and if so, what was the 
reason of a proceeding which seemed to us most strange. 
His Lordship* admitted the fact, and gave as his reason, 
that it was the opinion of himself and some other gentlemen, 
who had tried to form a Board of Health, that our hand-bills 
were calculated to frighten people, and therefore were not 
to be allowed. On being expostulated with as to the un- 
reasonableness and cruelty of such a step, and that it ex- 
ceeded the powers of the Police, he replied, " That the Police 
were omnipotent/' It is a pity he had not given them orders 
to arrest the cholera in that case. Of course we had nothing 
for it but to acquiesce in his absolute wisdom — although it 
did seem rather strange that his Lordship should show so 
much tenderness for the fears of the poor as to prefer allow- 
* The predecessor of the present Provost. 



276 ON EPIDEMIC CHOLERA 

ing them to die of cholera rather than alarming them by 
mentioning the word in their hearing ; — and it did not seem 
altogether consistent to allow the Town Council to discuss and 
make frequent mention of the ominous subject, and to permit 
what was said about it to be published in all the Newspapers 
of the place. Was there no danger of that giving alarm ? 

Although for a considerable time — some weeks — no efficient 
steps were taken by the city authorities for giving medical 
aid, yet from the first there was a sort of attempt made to 
obtain a report of all the cholera cases, which were daily 
published in the papers. This was first done by the police 
and Town Council, who sent their emissaries wherever 
a case of cholera was reported to be, to ascertain the fact, 
and certify it, as it was called. Accordingly, we thought it 
right to send a daily return of our cases to the Lord Provost, 
as it seemed his wish to obtain all information, whether he 
gave any to others or not. "We did this for some time, until 
we found that these police emissaries, or persons calling them- 
selves so, were using their endeavours to deter our patients 
from continuing under our charge, by speaking contemptu- 
ously of the medicines we gave them, and even by threaten- 
ing them with the loss of certain benefits which the town 
was to give to the poor people, unless they employed the 
parish doctor. After this we resolved to make no more 
returns, except to the Board of Health at London, to which 
body we accordingly sent a full report of every case of cholera 
which was treated by us, and we may give the following ac- 
knowledgment of their receipt, by the Secretary of the 
Board : — 

" The General Board of Health. 

Gwydyr House, Whitehall, 
IMh February, 1849. 

" Sir, — I am directed by the General Board of Health to 



IN EDINBURGH. 277 

acknowledge the receipt of your letter of the 23d instant, 
with the reports of cases of cholera forwarded therewith ; 
and I am to convey the thanks of the Board to the Physicians 
of the Edinburgh Homoeopathic Dispensary, for the valu- 
able information contained in those Reports. — I am, Sir, your 
most obedient Servant, 

ALEX. BAIN, Asst. Secretary. 

To G. Atkin, Esq., M.D., 
Homoeopathic Dispensary, 5, James* Square, Edinburgh. 

Although, as we before said, the cholera appeared about 
the beginning of October, it was not till the ] 8th that there 
was a daily report of the number of cases sent to London. 
The disease, although it still exists among us, and has 
broken out in a neighbouring village with great virulence, 
may be said to have ceased as an epidemic by the end of 
December : so that its course is included in the months of 
October, November, and December. The following tables 
show, first, the weather of these three months in the year 
1847 when there was no cholera, then the weather of the 
three months of 1848 when the cholera prevailed, and the 
number of cases each day from the 18th of October to the 
1st of January 1849. We are indebted to Mr. Adie, the 
distinguished optician, the well-known inventor of the Sym- 
phisometer, for the weather tables, and the most perfect re- 
liance may be placed on their accuracy ; and we are indebted 
to Mr. Bain, Secretary to the Board of Health, for the daily 
returns of cases of cholera. We shall not attempt to draw 
any conclusions whatever from this table, but publish it in 
the hope that similar records may be kept in all places 
where cholera prevails. We should advise that in addition 
to the particulars we have given of the weather, the dew- 
point should be noted, and also the state of the atmospheric 
electricity. 



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ON EPIDEMIC CHOLERA IN EDINBURGH. 281 

We believe the best way of giving an accurate idea of our 
proceedings will be by the following extracts from the 
Report of the Acting Committee of the Homoeopathic Dis- 
pensary, and we consider it but justice to those Homoeopathic 
practitioners who devoted themselves to the toilsome, often 
thankless and perilous duty, that their names should be 
thus recorded : — 

" Whenever the existence of Asiatic cholera in Edinburgh 
— an event, as appears from your minutes anticipated by 
you since the 8th November last — had been officially an- 
nounced, it seemed to your Committee that the time was 
come for them to use the most prompt and efficient means 
in their power, at least to alleviate if they might not stay 
that terrible disease. 

" With this view a meeting of your Committee was held 
on the 7th October current, when it was resolved, after con- 
ference with your medical officers, the ordinary physicians 
of the Dispensary, who generously undertook the very severe 
duties which the arrangement imposed on them, that the 
Dispensary should be kept open, and one of the medical 
officers should be in attendance, at all hours, day and night, 
during the prevalence of cholera in Edinburgh. It is here 
to be mentioned that the ordinary physicians, viz. — Dr. 
Russell, Dr. Wielobycki, Dr. Lyschinski, and Dr. Sutherland, 
all graduates of our University, have been kindly assisted 
in these duties by Dr. Atkin of Portobello, who has a similar 
degree, and Dr. Cockburn, a licentiate of the College of 
Surgeons of Edinburgh ; and when it is considered that the 
services of these gentlemen are perfectly gratuitous, your 
Committee feel sure you will accord them your warmest 
thanks. Arrangements have also recently been made to 
enable Dr. Cockburn, in the meantime, to be resident in the 
Dispensary. 



282 ON EPIDEMIC CHOLERA 

" As the only effectual means of giving notice to the class 
of persons most liable to the disease, that medical aid was 
to be obtained at the Dispensary at all hours, day and night, 
bills announcing the fact and urging the importance of in- 
stant application, were ordered to be printed and posted at 
all proper places ; and generally, your medical officers were 
empowered to take whatever steps, such as the employment 
of nurses, &c, they might think necessary to meet the crisis. 

"Your Committee again met on the 14th, when it was 
stated that there was reason to believe that the bills which 
your Committee had published had been destroyed by the 
police, and the person employed to put them up had been 
apprehended for doing so ; and your Secretary was requested 
to inquire into the matter, and on inquiring, your Secretary 
learned from the Superintendent of Police, that the bills 
had been destroyed in terms of orders issued by the Lord 
Provost. He then wrote the Lord Provost, (October 16th,) 
to ask whether it was his intention to prevent the publica- 
tion of such bills as those referred to, and if so, in what re- 
spect they were objectionable. His Lordship replied, ' It 
was the opinion of the gentlemen who met with Dr. Suther- 
land from the Board of Health, that the placarding of bills 
about cholera had a pernicious influence by creating alarm 
in the public mind, and therefore ought to be prevented ; in 
consequence of which opinion/ he ' gave orders to the police 
to prevent placarding of all such bills/ 

" Your Secretary afterwards waited on the Lord Provost 
on the subject, and finding him still resolved to prevent the 
publication of these bills, gave orders to have others printed, 
and put up especially in the Canongate, Cowgate, West 
Port, and other places in which the cholera had already ap- 
peared, containing the same announcement, but not contain- 
ing the word ' Cholera/ at that time prohibited. 



IN EDINBURGH. 283 

" It will thus be observed that, while the authorities were 
taking no steps themselves to provide medical aid, and after 
numerous cases of cholera had occurred in Edinburgh, they 
still persisted in offering obstructions to your Committee, 
who were then anticipating the steps which have been so much 
more tardily taken by the parochial authorities, acting in 
obedience to the orders of the General Board of Health. 

" Of all the cases which have come under the notice of 
your medical officers, there is no reason to believe that any 
one has originated in e alarm" or ' panic ; on the contrary, 
it has been observed by them that the patients have in 
general been rather too indifferent than too anxious. 

" In terms of the announcement thus made public, the 
Dispensary has been open at all hours, day and night, since 
the 9th current ; your medical officers, and the other two 
gentlemen who are acting with them — six in all — having 
arranged to relieve each other every twelve hours, at 9 a.m. 
and 9 p.m. 

" It may be here stated, that the Lord 'Provost having 
published an advertisement requesting daily returns of all 
cases of cholera that should occur in Edinburgh, your Se- 
cretary, on the 23d October, sent his Lordship a report of 
the cases that had already occurred, at the same time writ- 
ing to inform his Lordship what steps had been taken by 
your Committee, and has since made a daily return cor- 
responding with that which has just been read/'* 

The Second Report takes up the subject at the point 
where it is left off in the First. 

" The general arrangements which were made on the first 

incursion of cholera, continued in operation at the dispensary 

during the whole of its course, and the most effectual means 

were used to give public notice that medical assistance was 

* Report, October 8 to October 27, 1848. 



m-'i- 



284 



ON EPIDEMIC CHOLERA 



to be obtained there at all hours, by the posting of hand- 
bills, and by circulars addressed to those frequenting the 
dwellings of the poor. That these measures were much 
needed, and quite successful, appears in the very large pro- 
portion treated by the physicians of the dispensary, being 
more than one-fourth of the whole cases of cholera reported 
to the General Board of Health as having occurred in Edin- 
burgh and Leith. 

" The first case occurred on the 8th October, the last on the 
11th February ; the disease having continued in Edinburgh 
rather more than four months. It reached its maximum 
about the beginning of December — the greatest number of 
new cases in any one week ending December 3d, and being 
thirty-four ; after which time the number of cases decreased 
rapidly, and during the last week of January only three new 
cases were reported. Not more than one or two stray cases 
occurred afterwards. The following table shows the progress 
of the disease : — 



TABLE OF THE NUMBER OF CASES AND RESULTS EACH 


WEEK. 


Week ending 


Remaining. 


New. 


Total 


Recoveries. 


Deaths. 


October 15 

... 22 


6 

9 

7 

9 

7 

10 

11 

16 

7 

10 

6 

1 

6 

1 

1 

3 

1 


19 

25 

15 

19 

12 

25 

23 

34 

20 

14 

8 

4 

5 

4 

6 

3 

"i 


19 

31 

24 

26 

21 

32 

33 

45 

36 

21 

18 

10 

6 

9 

6 

4 

3 

1 

1 


8 

18 

10 

11 

12 

15 

17 

22 

22 

10 

11 

8 

1 

6 

3 

1 

3 

"i 


5 
4 

7 
6 
2 

7 
5 

7 
7 
1 
1 

1 

2 

2 


... 29 

November 5 

12 

19 

26 

December 3 

10 

17 

24 

31 

January 7 


... 14 

... 21 

... 28 

February 4 


... 11 

18 





IN EDINBURGH. 285 

" Thus the total number of cases, after deducting all doubt- 
ful ones, is 236; of these 179 recovered, and 57 died. This 
gives a mortality of 24.15 per cent., — a very serious mortality 
certainly ; and very lamentable it is that; nearly one-fourth 
of all who took cholera should have died ; the virulence of 
the disease appearing also in this, that the average duration 
of the fatal cases was no more than fifty-eight hours. Still 
there is much comfort in the thought, that under the treat- 
ment employed by the Medical Officers of the Dispensary, 
the mortality was so much less than the average mortality 
in Edinburgh during the same period, and, except in the 
matter of medical treatment, under similar circumstances ; 
and in the assurance thence arising that many human lives 
have been saved, and thus the most anxious efforts have 
been amply recompensed. 

"We have received from the General Board of Health the 
following return of the total number of cases of cholera in 
Edinburgh and Leith, (which appear to be classed together,) 
with the result — 

Attacks. Deaths. Recoveries, 

876 492 244 

which gives a mortality of rather more than 56 per cent. ; or 
if we deduct from the total number of cases reported, those 
which were reported from our Dispensary, with the corre- 
sponding results, there will remain 640 ; of which 435 died, 
and 65 recovered : which gives a mortality of within a small 
fraction of 68 per cent, of the cases treated otherwise than 
Homceopathically ; while as above stated, the mortality 
among those treated Homceopathically wsls only 24.15 percent. 
" It was stated in the former report on this subject, that in 
some instances the patients, when visited by the Physicians 
of the Dispensary, were found in so great destitution, (being 
without food, fuel, or clothing,) that it was necessary to send 



286 ON EPIDEMIC CHOLERA 

them immediately to the Infirmary; and an attempt has 
been made to diminish the value of the differential statistics 
just given, by suggesting that the worst cases were sent to 
the Infirmary, and thus the proportion of deaths apparently 
lessened. To correct this error, it is only necessary for us 
to repeat emphatically what has been already asserted, that 
in no cases except those above referred to, and one or two 
others, when it was done by the express desire of the pa- 
tients, were any sent to the Infirmary ; and that it became 
less necessary to use that extreme measure after food and 
blankets had been provided for the patients. 

" That the labour of the Physicians was great, will be easily 
understood, when it is considered that upon six of them (at 
the most, and there were seldom so many) devolved the whole 
duty of giving constant attendance at the Dispensary, which 
continued to be open at all hours, day and night ; and of 
visiting during one week forty-five patients, each of them 
perhaps four or five times a-day ; and these not gathered into 
an hospital, nor even confined to one district, but scattered 
over the city and its suburbs, from Leith Walk to Bruntsfield 
Links; and residing very often in the remotest and most in- 
accessible localities. Add to this labour the anxiety and 
mental suffering, without which no right-hearted man can 
witness the cruel ravages, especially among the poor, of a 
disease in all its features so appalling, and before which, at 
least when fully developed, the most skilful treatment be- 
comes comparatively powerless, and there will appear large 
acknowledgments due to those who willingly undertook and 
manfully discharged these painful duties. 

" The Committee take this opportunity of recording their 
high sense of the value and desert of these services ; and 
would, at the same time, tender cordial thanks to those who, 
by providing food and clothing for the most destitute of the 



IN EDINBURGH. 287 

patients, not only relieved their sufferings and promoted 
their recovery, but in so great measure lessened the anxieties 
of their medical attendants, who have frequently and warmly 
expressed their thanks for this kindness. There remains as 
the fruit of these labours, not only the good which has been 
already experienced in the cure of the sick, but a large pro- 
vision for future use in the valuable details of all the cases, 
which have been carefully collected and preserved in the 
cholera books of the Dispensary/' 

We believe that in all the circumstances of the case, these 
arrangements were the best possible, and if the cholera spreads 
over England this year, as there is a great probability of its 
doing, we should recommend similar measures to be taken 
in all places where Homoeopathic aid is attainable. Above 
all, in London this should be done, and we trust that if the 
Metropolis be visited with the scourge, that the British 
Homoeopathic Association will show itself alive to the crisis, 
and take the most energetic steps to establish temporary 
dispensaries in all localities where the disease appears. All 
that is required to be done is to engage a couple of rooms, 
to post up bills announcing the fact, and to secure the assist- 
ance of one or two Homoeopathic physicians, who should have 
a sum of money placed at their disposal, to pay for nurses 
to be left with patients and superintend the treatment ; and 
if possible at each dispensary there should be a resident 
medical officer. We cannot for a moment suppose that the 
wealthy and generous capital of our empire will refuse an 
ample fund for all these purposes. The good which may be 
done by it is literally incalculable, and if the friends of the 
cause come forward in the handsome way they did here, let 
it never be said that the Homoeopathic physicians drew 
back ! Surely at such an emergency, when the lives of so 
many are at stake, it would be most unworthy of any man 



288 ON EPIDEMIC CHOLERA. 

who really believes that he can save his fellow-creatures by 
administering Homoeopathic medicine, not to make his 
actions a confession of his faith. We can only say for our 
own part, that although the attendance upon the poor af- 
flicted with cholera in Edinburgh was no easy or pleasant 
task, yet it is one we should have been ashamed to have 
evaded, and one which has given us more real gratification 
than any professional duty we have ever engaged in. It is 
not so often that the chance occurs of being able to rescue 
life from instant destruction ; and the pleasure derived from 
the deed far out- weighs all the sacrifices required in the 
doing of it. Let us hope then, and trust, that as when the 
news of the disastrous field of Flodden came here centuries 
ago, it united all the inhabitants of our ancient town to re- 
solute, united action, by which the wall which still in part is 
standing was built, men working with the sword by their 
side, helping one another in this lasting memorial of the in- 
domitable character of our nation ; so this, great crisis may 
unite all those who believe in the doctrines of Hahnemann, 
to make an efibrt worthy of his memory, worthy of a far 
more glorious vocation, which is no less than being fellow- 
workers with Him who gives ear to the "sighing of the pri- 
soner/' and " preserves those that are appointed to die/' 



APPENDIX. 



CASES TREATED AT THE HOMCEOPATHIC DISPENSARF, EDINBURGH, 

IN 1848-49. 

I have selected the following cases for publication rather to illus- 
trate the varieties of the disease, and the corresponding treatment, 
than for the brilliancy of the results. At the same time I believe 
that on the whole our success has been as great as that of other 
Homoeopathic practitioners ; and I do not feel at all called upon to 
apologize to those who, having themselves never seen or treated a 
case of cholera, have criticised our treatment, and represented our 
mortality as greater than we ought to have had in the circumstances. 
To all such objectors we reply, that we are fully aware of the faults 
we have committed ; and should the cholera return, we hope to be 
more successful ; but that hitherto there were almost no cases of 
cholera treated homceopathically upon record, and it is only those 
who have had to do with the disease who can form an adequate 
idea of its virulence, or of the difficulties attending its successful 
treatment. Of course I do not hold myself personally responsible 
for the accuracy of all the Reports. Each of us had his own 
patients, and we did not interfere with one another more than 
necessary. It was my habit, as well as that of some of my col- 
leagues, to make notes at the bedside of the patient after every visit, 
and to copy those notes into the book kept for the purpose at the 
Dispensary ; and I should strongly advise that this method be fol- 
lowed by all who may have anything to do with the treatment of 
the epidemic. Those who did not take notes at the bedside of the 
patient made their report on their return to the Dispensary ; and 



290 APPENDIX. 

we have no doubt that on the whole the reports are more faithful 
than the ordinary history of cases, except those which occur in hos- 
pitals, where accuracy is much more easily attained. 

In making out our returns of cholera cases we have used our 
best endeavour to enter none as cholera which did not present the 
most unequivocal symptoms of the complaint. We need hardly 
observe that there is considerable liability to error in this matter ; 
and we may have entered as cholera, cases which others would not 
have looked upon as presenting sufficiently characteristic symptoms 
of the complaint. Before we made up our final list from which the 
mortality is taken, we did all we could to purge our book of all 
dubious cases, and reduced the number from 365 to 236. 

We have arranged the cases in the following order: — First, 
Those which were fatal in the second and third stage of the disease. 
Second, Those which rallied from the state of true cholera and 
afterwards sunk in the typhoid state. Third, Cases of recovery 
from the first invasion of the disease. Fourth, Recovery after it 
had been fully formed. And Fifth, Recovery from the typhoid 
state. 

FATAL CASES. 
Case I. 

The first case of cholera, which was treated homceopathically 
towards the end of the attack, was that of A. M., an Irish married 
woman, who came from Glasgow three days before, (the 5th of 
October,) to take refuge in the house of her sister, living in the 
second floor of a crowded, filthy locality in the West Port. She was 
shocked to find that her sister had died the same day of cholera, 
and the husband of the defunct died of it two days afterwards, and 
was lying unburied in an adjoining dark, small room. Our patient's 
age was 25, she was of fair complexion, small stature, slender, deli- 
cate, and exhausted by nursing her child eighteen months old, and 
by want of food for the last three or four days, her husband having 
been out of work for some weeks. She was taken ill at about four 
o'clock on Sunday morning (the 8th of October) with purging and 
vomiting, got rapidly weak, could not stand nor sit up from vertigo 
and noise in the ears ; took whisky repeatedly and vomited it ; was 
very thirsty, took beer, water, and vomited everything she drank ; 



APPENDIX. 291 

took also four opium pills between eight and nine o'clock, which 
had been left by an ordinary practitioner for her sister and brother- 
in-law before their deaths ; but the vomiting and purging, with 
pains and cramps in the legs, at last became alarming. Some of her 
neighbours, formerly patients of our Dispensary, having observed 
the notices of our Dispensary being open at all hours, day and night, 
for receiving application for medical aid during the prevalence of 
cholera., sent there, and after breaking open the door, which had 
been locked by her cousin while she went for the Parish Surgeon, 
she was seen first about half-past eleven, a.m., and found in the 
utmost destitution and poverty, without any covering or fuel, and 
she was then in a state of collapse; pulseless, cold and deaf; lying 
prostrated on the same dirty bed, which bore the marks of the alvine 
evacuations ejected by the former two patients, who died upon it 
of cholera before her ; and a naked child, eighteen months of age, 
was at the right breast greedily sucking her insensible mother, who 
was in a stupor from the effects of opium ; but she was soon roused 
by the cramps, which starting from the extremities towards the ab- 
domen, were relieved by vomiting a large quantity of watery, 
whitish, flocculent liquid, which ran over the head and face of the 
infant ; after vomiting she had hiccough, and drank a large quantity 
of cold water, which made her sick and vomit again in gushes, and 
the vomited watery liquid was in a much larger quantity than what 
she drank ; voice husky. 

Cam ph. every five or ten minutes. 
In the meantime, by threatenings and by force, some blankets were 
procured from the neighbours, the fire kindled, and hot sand and 
hot bricks applied round her, and the child sent to the Charity Work- 
house. The cramps were greatly allayed ; they became less intense 
and less frequent ; they came on every twenty and thirty minutes, 
chiefly in the feet and in the left leg and the left arm ; the gastroc- 
nemii and the sartorii were most violently cramped when she at- 
tempted to change her position. The cramps, the leaden coldness and 
blueness of the extremities, the pulselessness at the wrists, with 
bluish, cold, and flabby tongue and lips, the cold breath, and the dark 
circles around the sunken, half-open, and turned up eyes, continued 
for more than an hour, during which she vomited three times the 
same clear watery flocculent fluid, with a frothy liquid at the close 
of each vomiting and a hiccough. She said also, that a gush of 



292 APPENDIX. 

watery, scalding discharge came from her bowels almost each time 
she vomited, and that she could not make water. 
Ars. 3, every quarter of an hour. 

She had no cramps for about half an hour, was also warm and 
perspired profusely under the blankets ; the perspiration on the 
trunk was warm, and on the face and extremities cold ; pulse per- 
ceptible, 140 in a minute, weak ; the livid hue was gone; the lips, 
tongue, and fingers became whitish, pale, ensanguined, and warm, 
her voice firmer, louder, and clearer; her breathing easy, 28 times 
in a minute ; but she was still very thirsty. On the whole the case 
had an appearance of being likely to terminate favourably ; even 
when the Police Surgeon inquired, (about half-past two o'clock,) the 
pulse was then ranging between 120 and 140, and she had no cramps 
nor vomiting nor purging for nearly two hours ; but this favourable 
state was short-lived, slight cramps recurred a little before four 
o'clock, they were chiefly in the thorax, with oppression in breathing, 
and the pulse began to falter. 

Cuprum 3, dry on the tongue. 

At her own request she got a little gruel, which she vomited ; 
became more thirsty and very restless ; very anxious to get up, 
flung about her arms from breathlessness, which gruadually became 
more and more oppressive, and made her cry repeatedly, " I am 
dying ! " the pulse became again completely extinct ; at half-past 
four, p.m., respirations from 32 to 38 in a minute, sonorous, labori- 
ous, with sighing, gasping, and an exclamation, u I cannot have ease 
in this world ! " The face, lips, and the whole body got cold like 
ice again ; hands and legs paralytic ; she became restless, speechless, 
and could not swallow anything after some brandy and water was 
given to her; lying insensible; the fingers crooked, their integuments 
shrivelled, corrugated ; the nails dark blue, and the breathing, inter- 
rupted by gasping or risus sardonicus, followed by a few futile 
gasps for breath, which were the last of her poor exhausted life. 
After death, which took place a little before five o'clock, p.m., that 
is, after thirteen hours' illness, the whole body became warm again, 
and a few post-mortem contractions took place before it cooled. 

Case II. 

M. S., a woman aged 30, living in a miserable, filthy, crowded 
room, a notorious drunkard, who had been drunk the previous day 



ArPENDIX. 



293 



and night, was seized at four o'clock on the morning of the 1 Oth of 
October, with cramps in the stomach and limbs, and purging and 
vomiting. She had taken two opium pills of three grains in each. 
Pier friends having heard of our Dispensary being open, and not 
knowing where else to find a doctor, sent there about eight o'clock. 
When seen she was cold, pulse imperceptible; there was violent 
vomiting. She got Camphor, and afterwards Veratrum, Arsenicum, 
Ipecac, and Cuprum. At one o'clock the pulse was perceptible, and 
there was no vomiting nor purging. She seemed a little better. She 
sunk rapidly, and died at five o'clock, p.m., without the least strug- 
gle. So complete was the collapse, that it was impossible to say for 
some time whether she was dead or living. 

Case III. 

A woman, aged 33, has been for many years, especially the last 
two, very intemperate. Was drinking to excess on Monday, and 
to some extent for the two succeeding days. Four months preg- 
nant. Wretchedly poor, lying on a piece of cloth on the floor, and 
naked, covered merely with a tattered gown. Was seized at five 
last night with vomiting and purging. Had taken porridge for sup- 
per, which was returned ; the evacuations at first watery, latterly 
described as bloody. Since morning evacuations less frequent. 
Cramps began about seven last night, and were very severe all 
night ; abated since morning. Seen at noon of the 12th of October. 
Skin of the whole body cold and clammy, the hands and face blue, 
the features contracted and sharpened, eyes deeply sunk ; eyes and 
mouth surrounded with blue circles ; tongue and roof of mouth cold, 
the former covered with yellowish fur, felt flabby like a piece of 
raw meat ; breath cold ; no pulsation could be detected at the wrist, 
temporal artery, or heart ; breathing regular ; complained of pain 
in epigastrium, increased on pressure, great thirst ; oppression of 
the chest; throwing off the covering, complained of its weight; 
vomited about half an hour after she was seen, clear water, without 
smell, and apparently unmixed with mucus; evacuations from the 
bowels at intervals of half an hour, of a dusky red watery fluid, con- 
taining brown and white flocculi ; was sensible when bowels were 
moved, and complained of some heat in ano ; no urine passed since 
the previous evening. Sensible when spoken to, but wandering at 
times, and talking indistinctly ; voice hoarse. 



294 APPENDIX. 

Verat. 3, and Ars. 3. 
Medicines repeated at intervals of twenty minutes, hot bricks ap- 
plied round the body, and arms and legs chafed. 

Had three stools, and then an intermission of about three hours. 
Skin of the extremities slightly warmer, but temperature of the 
mouth unchanged ; restless, and complaining of great oppression at 
the heart, exclaiming it was bursting, and begging the weight to be 
taken off her chest; the cramps gradually diminished in strength and 
frequency. The voice varied much, at one time being clear and 
distinct, at another hoarse and husky ; the blueness of the hands 
and face diminished, and the eye increased in clearness ; the pain 
in the stomach not felt. 

Continue Verat. and Ars. 

At half-past two, took a tablespoonful of thin gruel, which was re- 
tained. At three, a stool, tho same character ; complaining much 
of chest and heart oppression. At half-past three, asked for more 
gruel, which she drank greedily, and the temperature of the thighs 
and surface of the abdomen sensibly increased ; no pain on pressure 
in the latter ; sleeping at times for a few minutes. At a quarter to 
four, the respiration became suddenly oppressed and laborious, chest 
heaving, and at four she died. 

An interval of a few minutes from the respiration ceasing, there 
were movements of the right shoulder, it was three or four times 
twitched forward ; there was no struggle or convulsion, the respira- 
tion ceasing gradually. The stools and the water vomited had no 
smell. 

The house was most wretched, several openings through the roof, 
the window stuffed with pieces of cloth, the floor very defective, with 
an oppressive smell arising through it. The husband had been 
drinking, he went out a little before the wife's death and returned 
scarcely able to stand. 

Case IV. 

P. M., aged 46, a man of intemperate habits, living in a close 
room, with several other persons of both sexes, in a filthy lane off 
the Grassmarket, had been in his usual health, and had no diarrhoea 
till Jive o'clock, a.m. of the 20th of October, when he was suddenly 
seized with vomiting and purging. When seen for the first time at 
ten, a.m., we found him out of bed, standing almost naked on the 



APPENDIX. 295 

floor ; be said he had risen on account of the violence of the cramps. 
The surface of the body was quite cold, the tongue cold, the pulse 
could not be felt, the toes were quite turned in by the cramps, and 
he complained much of the violent pain in his legs. He was vo- 
miting and purging a watery fluid. 

He died at a quarter before ten, p.m., seventeen hours after seizure, 
and twelve hours after first visit. 

Case V. 

R. A., aged 22, a man of sober, industrious habits, living in a 
comfortable room, without feeling unwell, took a dose of salts and 
senna as a precautionary measure, on the morning of the 22d of 
October, which operated in the course of the day. At four, p.m., he 
was seized with vomiting, purging, and cramps. When seen at 
half-past seven, p.m., the surface of the body was cold and dark- 
blue in colour ; the pulse was felt like the finest thread ; the jaw 
was hanging, and the eyes open, glassy, and turned up ; the tongue 
and breath were icy cold ; the voice a hollow whisper ; there was 
great thirst, watery vomiting and purging, and violent cramps in 
legs and arms. 

He died at half-past one, a.m., of the following morning, nine hours 
and a half after seizure, and six hours after first visit. 

Case VI. 

R. A., aged 30, a man of intemperate habits, who had been drink- 
ing whisky the previous day, but otherwise in his usual health. 
He was seized with vomiting and purging and cramps about mid- 
night of the 24th of October, and when seen at five o'clock the next 
morning, he was found standing on the floor roaring with pain. His 
face was pale and anxious ; his lips and breath were quite cold ; no 
pulse couid be felt, and he could not move from where he stood from 
the violence of the cramps. Alvine evacuations watery, what he 
vomited was tinged with blood. 

Camphor to smell, and afterwards Arsenicum, 3rd dil., 
frequently repeated. 

Half-past eight, a.m. — Profuse warm perspiration over the whole 
body ; no vomiting or purging ; slight cramps ; urine suppressed ; 
great thirst ; pulse barely perceptible. 

Eleven, a.m. — Countenance cadaverous; very breathless; moan- 



296 APPENDIX. 

ing from pain. Sunk and died at half-past one, p.m., twenty-five 
hours ill, and twenty hours under treatment. 

Case VII. 

J. M., aged 34. He was seen at nine, a.m., of the 26th, and he 
was then cold, blue, and pulseless. Complained of cramps in the 
stomach ; there was ineffectual desire to relieve the bowels. 
Hydrocyanic Acid, 1st dil., a dose every five minutes. 

He got this for half an hour without any perceptible change, and 
afterwards Arsen. 3d dil., every quarter of an hour. He sunk 
gradually and rapidly, and died at twelve o'clock the same day. 
Only three hours under treatment. 

Case VIII. 

Mrs. M., aged 45, had been in good health till last night, when 
she was affected with diarrhoea; at six o'clock of the 2.9th October, 
she was attacked with watery vomiting and purging, and cramps in 
the limbs. She was first seen at half-past eleven, a.m., of the same 
day, and we found her face sunken, her hands and nails blue and 
shrivelled; the pulse could not be felt ; the voice was barely audible ; 
the tongue and breath were quite cold. 

Camphor every five minutes. 
Half-past one. — No better. 

Arsen., 3d dil., half-hourly. 
Half-past ten, p.m. — No better. 

Hydrocyanic Acid, 2d dil., every ten minutes. 
October 28th, half-past three, a.m. — No better. Continue medi- 
cine. 

Eight, a.m. — Tongue warmer ; no pulse ; great thirst ; no vomit- 
ing for some hours ; no purging for one hour ; complains much of 
pain in abdomen. 

Oxalic Acid, 3d dil., a dose half-hourly. 
Half-past one, p.m. — One stool since last report ; no pulse ; great 
pain in the abdomen ; tongue cold. 

Arsen., 3d dil. 
Half-past eight, p.m. — Low muttering delirium ; no pulse ; quite 
cold ; cannot be roused by speaking to her ; no vomiting ; two stools 
since last report. Died at half-past nine, p.m. 



APPENDIX. 297 

Case IX. 

E. M., aged 40, a woman of intemperate habits, and who had 
been drinking much the last few days, was for three days ill of diar- 
rhoea and pain in the side, which had confined her to bed for two days. 
When seen for the first time, at half-past nine o'clock, p.m., on the 
27th October, she was found covered with cold, clammy perspira- 
tion ; the pulse was imperceptible; she complained much of oppres- 
sion and of heat, and vomited everything she took ; she had also 
watery purging. The tongue was cold, with a white fur upon it ; 
the eyes half-open and turned up. Had been treated by an Allo- 
path up to the hour of our visit, who had given pills, and creosote, 
and brandy. 

Hydrocyanic Acid, 2d dil., a dose every quarter of an hour. 

Half-past ten, p.m. — No vomiting; no other change. 
Arsen., 3d dil. 

Died at half-past eleven. Two hours under our treatment. 

Case X. 

Mrs. F., aged 46, went to bed in her usual health between nine 
and ten, p.m., on the 29th of October ; felt pain in the head and 
chilly during the night, and especially between three and four o'clock 
the following morning, when the bowels were copiously moved, and 
she began to vomit with each evacuation of the bowels, which oc- 
curred every eight or ten minutes ; had also cramps in the legs and 
pain at epigastrium. When seen first, a little after six o'clock of 
the same morning, her face was cold and ghastly, and had a pecu- 
liarly melancholy expression ; she frequently repeated the words, 
" What is with me ? I cannot live, I cannot live." She was very 
restless ; the pulse languid and intermittent, and the skin ice cold ; 
she complained of pain in the loins. 

Secale, 1st dil., every five minutes. 

After a little time she was violently cramped in the fingers and 
toes. She then got Camphor, repeated at short intervals. There 
was no vomiting for quarter of an hour; pulse became more lan- 
guid, 76 in a minute, scarcely perceptible; vomited and purged 
twice during the next quarter of an hour ; very restless ; sighing 
and panting for want of breath. 

She then got Arsen., 3d dil. 

Quarter past seven, a.m. — Pulse gone; cold, clammy perspira- 



298 APPENDIX. 

tion ; vomiting of a pale-white watery liquid, with gurgling in the 
throat. 

Carbo. veg., 3d trit., alternately with Ipecac, 3d dil. 
Nine, a.m. — Collapse continues. Vomited once, and bowels not 
open ; fits of excessive restlessness, and cramps occasionally in the 
fingers and toes. Continue medicine. 

Twelve, noon. — Much the same; no vomiting or purging; great 
thirst ; flying pains through the body. 

Pulsat., 3d dil. 
Three, p.m. — No change. Voice became a whisper. Her words 
were, " There will never be ease for me in this world." 

Eight, p.m. — Has been quiet and speechless from five, p.m. Is 
quite insensible. Bowels twice opened. Died at half -past eight, 
p.m., of the 30th. 

Case XI. 
Mrs. G,, aged 66, had been slightly unwell the previous week, 
and in attendance upon a person ill of cholera on the previous day. 
She was taken ill early in the morning of the 11th of November, 
with violent purging of watery fluid, and afterwards with vomiting; 
had taken brandy without any relief. We saw her for the first 
time at half-past eight, p.m., of the same day. Her face was pale, 
and had a peculiar expression. She was very languid, and spoke 
little; the pulse was 100, feeble; the tongue white and clammy. 
She had passed very little urine during the day ; she complained 
of cramps in the legs. 

Iatropha Curcas, 3d dil., a dose every hour. 
October, 12th, ten, a.m. — She was cold; pulse very weak, 68 in 
the minute; had passed no urine; vomited incessantly. Tongue 
white and cold. 

Arsen., 3d dil., a dose every half-hour. 
12th, half-past two, p.m. — She was warmer; there had been less 
vomiting and purging. She was said to have passed urine. Con- 
tinue medicine. 

Nine, p.m. — Very little purging and vomiting; tongue cold; pulse 
60, very small and feeble. The hands are dark-blue. Great thirst. 
Continue medicine. 

13th, six, a.m. — The medicine had not been given, but she got 
porter, and whisky and hot water, and had been altogether neglected. 
She died in the course of the day. 



APPENDIX. 299 

Case XII. 

Mrs. G., October 22. — The mother of this patient (Case XI.) died 
of cholera. We found this woman, her brother, a lad of 17 
years old, and two children, lying on a miserable shake-down on the 
floor. She vomited this afternoon, but felt quite well when she 
went to bed. About half-past eleven she was seized with sickness 
and purging, dejections coming from her in a watery stream. There 
was much pain in back, and dry retching. She had made water 
about half-an hour before. Surface of body warm; hands and 
face cold and clammy ; tongue cold, breath warm ; pulse indistinct ; 
great anxiety — often begged us not to leave her. Cramps in the 
leg. Was seen at twelve, P.M. 

Camphor, a dose every ten minutes. 

1 5th, half-past twelve, a.m. — Pulse more easily felt ; dry retching; 
much thirst. Quarter to one. — Cramps returning more severely ; 
purging more urgent ; great thirst. Temperature of the body as 
before. 

Arsen., 3d dil., and Verat., 3d dil., 
alternately every quarter of an hour. 

Seven, a.m. — Constant purging and vomiting all night. Com- 
plains of pain and oppression at heart. Pulse imperceptible ; sur- 
face cold ; tongue warm, voice hoarse ; weight at heart. 
Continue Arsen. and Verat. 

Nine, a.m. — No pulse ; very cold ; vomiting and purgiug clear 
water ; great heaving of the chest. Expects death. Continue me- 
dicine. 

Half-past twelve, a.m. — No pulse ; great oppression at the heart 
and chest. No purging; urinated a little two hours ago. Less 
vomiting ; hands and feet very cold. Continue medicine. 

Three, p.m. — No pulse ; no vomiting nor purging ; great oppres- 
sion of chest ; very livid. 

Hydrocyanic Acid, 1st dil. 

Seven, p.m. — Found that the patient died at four, p.m. 

Case XIII. 

Mrs. N., aged 33, was in attendance upon a person who died of 

cholera, and assisted to dress the body. She was quite well up to 

eight o'clock, p.m., of the 19th of November. Wo saw her first at 

nine, p.m., of the same day, and found her sitting by the fire, and she 



300 APPENDIX. 

said she could not lie in bed owing to the pain in the bowels. She 
had been vomiting and purging for an hour. The skin was hot; 
the pulse rapid and full ; the tongue cool. Complained of great 
thirst ; passed urine in the evening. Face flushed ; has drunk some 
whisky. The stools are thin and bilious. 

Camphor, to be followed by Merc, solub. 3d. 
] 9th, half-past eleven, p.m. — Vomiting and purging continue ; 
surface of the body becoming cold. 

Veratrum, 3d dil., every quarter of an hour. 
20fch, half-past one, a.m. — Surface cold; face and hands livid; 
purging clear watery fluid, with white flocculi ; grinding of the 
teeth ; pulse scarcely perceptible. 

Veratr., 3d, and Arsen., 3d dil., alternately. 
Half-past six, a.m. — Vomited and purged once since last visit. 
Skin cold ; eyes turned up. Complains of pain in chest ; respiration 
30 in a minute. Some attacks of hiccough, and spasmodic catching 
of the breath ; she rubs the chest with her hands. There are no 
cramps; the tongue, lips, and breath are very cold. 

Cicuta Viros., 3d dil., and Arsen., 3d dil., 
alternately every quarter of an hour. 
Nine, a.m. — Looks and feels better. No return of hiccough or 
catching of breath. Tongue cold ; pulse perceptible ; one watery 
stool. Continue medicine. 

November 20th, one, p.m. — Pulse gone; skin and breath cold; a 
clammy sweat on the face ; countenance very much altered, very 
dark -grey ; voice indistinct ; great thirst. 

Veratr., 3d., and Arsen., 3d, alternately. 
Eight, p.m. — There was great oppression of breathing at times, and 
she tossed about much. No pulse could be felt ; the skin was warm 
and dry; there was no urine. She has purged three times; no 
vomiting ; the eyes are turned up. 

Continue Veratr. and Arsen. 
21st, half-past two, a.m. — We found her lying very quietly ; and 
on being asked how she was, she said she was tired. There was less 
thirst, and there had been only two scanty watery stools, and no 
vomiting. She was restless ; the pulse could not be felt. There 
was grinding of the teeth, and twitching of the facial muscles; also 
slight quick spasmodic action of some fibres of the muscles of the calf 
of the leg. Continue medicine. 



APPENDIX. 301 

Nine, a.m. — She was much easier. No vomiting; the purging 
was more feculent, and the pulse perceptible. Continue medicine. 

Seven, a.m. — She was much worse. Since six o'clock the breath- 
ing had become oppressed. Constant desire to go to stool without 
any relief ; there was no pulse ; the tongue was clammy and cold ; 
the hands and face were discoloured ; there was no vomiting, but she 
complained of pain in the chest. Continue medicine. 

Nine, p.m. — Restless, but feels better ; voice stronger ; no pulse ; 
her face had a wild expression. Continue Arsen. and Verat. She 
complains of breathlessness. 

Half-past eleven, p.m. — The pulse was perceptible ; she com- 
plained much of shortness of breath ; the blood-vessels on the inferior 
half of the eyeball of both eyes were injected with blood ; there was 
no vomiting or purging. She died early the following morning. 

Case XIV. 

C. S., a woman, aged 25. Between the 8th and 9th month of 
pregnancy. Living in the same house with her sister, who dressed 
the body of a patient who died of cholera. She was seized with 
severe bowel complaint on Saturday night ; the purging which con- 
tinued has begun to diminish. Vomiting began 27th November, 
seven, a.m. First seen, three, p.m. Vomiting occurs about every 
quarter of an hour, ejections green ; has not urinated for two days, 
to-day passed a little ; severe pains in the stomach and back ; feels 
sick on raising her head ; pulse 60 ; skin warm. 
Arsenic, 3d, every half-hour. 
Half-past nine, p.m. — Purged once and vomited twice since visit; 
pulse 126, weak; countenance dejected; evacuations bilious. 
Camphor every quarter of an hour. 
28th, eight, a.m. — Pulse 98 ; vomited once ; purged three or four 
times, stools brown flocculent ; tongue and skin warm ; pain in uri- 
nating, urine scanty. 

Mercurius, 3d, every hour. 
Noon.— Vomiting and purging almost ceased ; feels much better. 

Continue. 
Nine, p.m. — Retching ; desire to vomit ; bowels moved four times 
to-day, with griping, stools thin, yellow ; pulse 92. 

Continue. 
29th, ten, a.m. — Slept from twelve to five this morning ; urinated ; 



302 APPENDIX. 

bowels three times moved, stools dark and liquid ; complains much 
of pain in back, and bottom of abdomen. 

Secale, 3d, every hour. 
One, p.m. — Vomited once a yellow fluid ; bearing-down pain in 
bowels continues ; pulse 70, full ; two yellow motions. 

Continue. 
30th, one, p.m. — Pulse, 102; pain in abdomen and back con- 
tinues ; movements of child not felt ; inclination to purge and urinate. 

Continue. 
Four, p.m. — Pain in back very severe ; purging of dark-brownish 
thin liquid. 

Six, p.m. — When heated gets sick ; vomiting, followed by pain 
in the back ; very thirsty ; skin cold ; pulse quick and weak. 
Bryonia, 3d, every hour. 
1st December, six, a.m. — Restless night; hands, face, and tongue 
cold ; inclined to throw off clothes; vomiting, with pain in back and 
breast ; voice hoarse ; no urine ; constant abortive desire to relieve 
bowels. 

Arsenic, 3d, hourly. 
Eight, p.m. — Vomited several times blackish stuff along with the 
water she drank, crying out from pains shooting from back to chest ; 
eyes sunk, and their lids much inflamed; expression almost moribund. 

Continue. 
2d, eleven, a.m. — Fits of oppressed breathing ; no purging; vomit- 
. ing of dark coffee-grounds looking fluid; skin and tongue cold; pulse- 
less ; the labia are swelled and black, and an offensive discharge 
issues from the vagina. 

Continue. 
Three, p.m. — Ruptured membranes ; the liquor amnii was eva- 
cuated. 

Secale, 0, every half-hour. 
Half-past three, p.m. — A few labour pains occurred. 
Eleven, p.m. — The os uteri dilated to an inch in diameter ; caput 
succedaneum forming; pulse distinct, 100; skiu, breath, lips, and 
tongue ice cold ; abdomen warm externally, and the liquor amnii 
felt warm ; there was no foetal pulsation ; the head of the foetus 
flabby and immovable ; no vomiting ; bowels opened once, stools 
dark, foetid ; desire to urinate. 

Continue. 



APPENDIX. 303 

3d, nine, a.m. — Restless all night from labour pains, but insen- 
sible; there was no thirst ; no vomiting nor purging. Through the 
day the breathing was laborious ; eyes turned up, half-open ; occa- 
sionally roused by pains, which must be very slight ; bloody dis- 
charge from vagina. The labour continued the whole night; she 
was quite insensible ; arms and legs paralytic ; the breath was 
shockingly foetid, it was necessary to keep the window open. 

She died 20 minutes past six, a.m., 4th December. Speechless for 
26 hours before death ; unable to swallow for 19 hours. The half 
of the head was born before she died. The woman in attendance 
pulled away the putrid foetus (a female) ten minutes after death. 

Case XV. 

Mrs. S., aged 23. Intemperate. Was drowsy the whole day 
yesterday and sick after meals. Was thirsty after supper ; took 
oranges and apples to quench her thirst. Was up till one this morn- 
ing, 13th December, attending to an eating-house which she opened 
a week ago, — a damp, dirty, smoky place. At one, p.m., to-day she 
began to vomit and to be cramped in every part of the body ; took 
some mixture sent by the surgeon at the cholera station, who how- 
ever has not seen her. Was seen about eleven, a.m., by another 
practitioner, who gave her a pill containing a grain of opium, a grain 
of calomel, and some grains of capsicum, to be taken after every loose 
stool, and brandy ad libitum. When visited at three, p.m., she was 
in a state of complete collapse ; pulseless ; face cold and clammy ; 
tongue and breath cold ; lips and cheeks livid ; dark sunken eyelids; 
eyeballs exposed ; eyes turned up. She was also cramped severely 
in both legs and in the haunches, and was crying out from pains in 
the right hypochondrium. During the visit a discharge of watery 
fluid from the bowels took place twice in gushes. 

Camphor occasionally. Arsenic, 3d, every quarter of an hour. 

Six, p.m. — Was removed from her eating-house home, a distance of 
about a quarter of a mile, an hour and a half ago, and placed in a 
room without fire. Was ordered to be brought into the kitchen and 
placed near the fire ; is quite pulseless ; ice cold ; has had no vomit- 
ing, but purged watery liquid thrice. 

Continue. 

Nine, p.m. — Pulseless ; tongue and skin cold ; covered with clam- 
my perspiration ; eyes turned up ; breathing oppressed ; less vomit- 



304 APPENDIX. 

ing ; purging continues ; cramps in legs ; complains of pain in back, 
'difficulty of breathing, and intense thirst. 

Arsenic, 3d, and Camphor, 3d, 
alternately every quarter of an hour. 
14th Dec, six, a.m. — Pulseless; vomiting only after drinking ; 
throwing off clothes, and wishes warm bottles removed ; purging 
continues ; says she passes a little urine when she coughs ; skin and 
tongue warmer ; respiration rapid, 48 in a minute, laborious ; rav- 
ing a good deal ; restless ; complains of weight on chest, which she 
wishes removed ; cramps in left leg. 

Continue. 
Nine, a.m. — Little change ; cramps less frequent ; purging con- 
tinues watery as she lies ; temperature of skin and tongue increased. 

Continue. 
One, p.m. — No cramps ; breathing oppressed ; pulseless. 

Continue. 
Five, p.m. — Pulse occasionally but very faintly perceptible ; hands 
feel cold and clammy ; breathing not much oppressed, thoracic ; 
vomiting ; only one small brownish stool ; no urine ; paralytic. 
Continue Arsenic. 
Nine, p.m. — Lying in the same state ; pulseless. 
Eleven, p.m. — Lying quiet ; skin of hands and face very cold. 

Continue. 
15th, half-past eight, a.m. — Slept at intervals through the night; 
no vomiting, urine, nor purging ; tongue warm ; face and hands 
cold ; pulseless ; less thirst ; breathing still laborious ; stupor, can 
be roused with difficulty. 

Continue. 
Half -past one, p.m. — Skin warmer; pulse 104; no purging; feels 
easier. 

16th, noon. — Restless through the night; pulse quite distinct; 
tongue dry and glazed ; purging green faeculent fluid ; much retching 
through the night, which stopped at eight, a.m. ; skin inclined to be 
cold. 

Arsenic, 3d, and Bryonia, 3d, alternately every half-hour. 
Ten, p.m. — No change. 

Continue. 
17th, Ten, a.m. — Pulse 90, weak; skin cold; breathing ster- 
torous, thoracic ; eyes turned up ; delirium. 



APPENDIX. 305 

Arsenic, 3d, and Rhus, 3d, alternately every quarter of an hour. 
Five, p.m. — Oppressed thoracic breathing ; pulse 72, weak ; skin 
warmer ; expression dejected ; speech impeded ; restless. 

Continue. 
18th. — Died this morning at six o'clock. 

The following four cases died after partially recovering from the 
second and third stages of the disease : — 

Case XVI. 

R. A., aged 24. — This young woman had been previously in per- 
fect health, and had attended her brother (Case VI.) during his last 
illness in his own house. She returned home the evening of his 
death, and was taken ill at ten, p.m., the same night. We saw her 
first at five, a.m., the following morning of the 25th of October. 
She was standing on the floor, supported by her mother, almost 
naked. The room was quite dark, and the only light we could 
procure was from the policeman's lantern who accompanied us up 
to the room. She was purging and vomiting violently, and throw- 
ing her arms wildly about. It was with difficulty we got her into 
bed. The surface of the body was cold ; the pulse was gone ; vio- 
lent cramps in limbs. 

Arsenic, 3d dil., a dose every quarter of an hour. 

Eleven, a.m. — She had been sleeping a little, and had vomited and 
purged only once since seven, a.m. The pulse was imperceptible ; 
the cramps less severe ; skin cold ; voice quite audible. 
Continue Arsen. 

Two, p.m. — No change. Continue medicine. 

Seven, p.m. — She is still much cramped, but her appearance is im- 
proved. The coldness of the surface is not so intense ; the breath 
is warm. 

Nux v., 3d dil., and Arsen., alternately every half-hour. 

Half-past eleven, p.m. — No pulse is perceptible ; the cramps still 
continue, though not quite so severe or frequent. She passed her 
fseces unconsciously ; she has been raving much, but when roused 
speaks sensibly. The tongue is covered with a white fur ; she is 
very thirsty ; her eyes are half-open and deeply sunk. Continue 
medicine. 

Oct. 26th, nine, a.m. — A little better, more sensible and more 

U 



306 APPENDIX. 

animated ; no pulse ; has bad some stools, attended with straining ; 
has had no vomiting ; there is pain at the epigastrium and abdomen ; 
there are no cramps, but she is very cold. 

Continue Arsen. and Yeratr. 
One, p.m. — The pulse was perceptible and rapid ; there had been 
two watery brown motions. 

Continue Arsen. and Yeratr. 
27th, six, A.M. — She is now warm ; there is no vomiting or purg- 
ing ; the pulse is perceptible, and 70 in the minute. 

28th, eight, a.m. — Pulse small and weak ; heavy expression of 
face ; great oppression of chest, heaving respiration ; no vomiting ; 
once or twice ineffectual desire to go to stool. 

Phosphorus, 1st dil., a dose every half-hour. 
Half-past one, p.m. — No better; dull, stupid; no pulse. 

Arsen., 3d dil., a dose every half-hour. 

Five, p.m. — Eyes fixed and glazed ; short heaving respiration 

almost total inability to swallow. She died at seven, p.m., of 28th. 

Case XYIL 

B. S., a healthy looking young woman of 21 years of age, living 
in a comfortable room, had been quite well till two o'clock, p.m., of 
the 2d November, when she became affected with nausea, for which 
she got some Allopathic drugs, after taking which she began to 
vomit. She was seen at half-past eleven o'clock, a.m., of the 3d ; 
had been vomiting clear water, and passing watery stools, all the 
previous night. The surface was cold; the pulse 120, feeble; the 
tongue red with frothy margin, and warm ; there was slight pain at 
epigastrium on pressure ; no pain anywhere else ; felt giddy when 
she rose. 

Secale, 3d dil., a dose every quarter of an hour. 

Half-past two, p.m. — No better ; violent vomiting of dingy fluid ; 
cold arms and hands ; pulse feebler. Had passed little urine the 
previous night. 

Arsen., 3d, and Yerat., 3d, 
a dose every quarter of an hour alternately. 

Half-past three, p.m. — Pulse scarcely perceptible ; much vomit- 
ing, lips and nose cold, breath warm ; complained of the urine being 
scalding. 

Cantharid., 3d dil., and Arsen., alternately. 



APPENDIX. 307 

Five, p.m. — Vomited twice and purged once since last report. 
Pulse 120 to 132, feeble. 

Ipecac, 1st dil., followed by former medicines. 
Half-past seven. — Vomited and purged twice; pulse 120; face 
bluish, cold ; tongue cold ; no cramps ; much pain in epigastrium. 
Arsen., 3d, every quarter of an hour. 
Quarter past nine, p.m. — She had taken cold tea, followed by 
vomiting, which had continued ever since. 

A dose of Ipecac, 1st dil., 
followed by Arsen., 3d, and Canth., 3d, alternately. 
Quarter to twelve, p.m. — No vomiting since last report. Purged 
once ; catching pain in the precordial region when she breathes 
deeply ; very thirsty, the more she drinks the worse is the thirst. 
Cuprum, 6th, one dose, and Arsen. and Canth. as before. 
Nov. 4, quarter past seven, a.m. — Had cramps about three 
o'clock in the morning in the calves of the legs and wrists ; vomited 
three times and purged twice ; so thirsty that she drank all the 
water in the bottle applied to her feet ; pulse 1 12, weak. She looks 
better, and the voice is stronger ; occasional cramps in the wrist. 
Cuprum, 6th, one dose, 
afterwards Arsen. and Veratr. alternately. 
Half-past nine, a.m. — Pulse 100; tongue and skin warmer; 
stools darker, more fseculent ; great thirst. 

Continue Arsen. and Veratr. 
Three, p.m. — Pulse 108 ; vomited three times a green watery fluid; 
bowels twice moved ; complains of burning in the throat ; no urine. 
Canth., 3d, and Arsen., 3d, alternately. 
Eight, p.m. — One copious brown stool ; pulse 90, wiry ; great 
thirst ; cramp in the leg. 

One dose of Cupr. Acet, 3d, 
and afterwards Arsen. and Veratr. every half-hour. 
Nov. 5, ten, a.m. — Much better ; skin, and breath, and tongue 
warm ; slept several times for a short time ; has had much inef- 
fectual desire to make water. 

Canth., 3d, and Arsen., 3d, alternately every half-hour. 
Eleven, a.m. — Pulse 88, stronger; purging a little brown water; 
less thirst. 

Arsen., 3d, half-hourly. 
Nov. 6, one, a.m. — Sound asleep, quite warm, and pulse natural. 
Continue medicine. 



308 APPENDIX. 

Half-past eleven, a.m. — Bowels were moved two or three times, 
and the evacuations were reported to be dark. The tongue is dark- 
brown ; pulse 88, strong. Complains of much general uneasiness ; 
no urine has been passed. Ordered a little arrow-root. 
Tereb., 3d dil., hourly. 
Half-past eleven, p.m. — The tongue is dry and red ; pulse 88 ; 
great general pain complained of ,• bowels once moved; inflamma- 
tion of the eye. 

Continue Tereb. 
November 7, half-past nine, p.m. — Bowels only once moved to- 
day, the evacuation dark and thin ; some urine passed ; face flushed ; 
tongue red ; breathing oppressed. She had got up and gone into 
the kitchen, along a stone floor, and had eaten a part of an apple. 
Bellad., 3d dil., a dose every hour. 
8th, half-past nine, p.m. — Little change ; had passed urine three 
times. 

Arsen., 3d, and Bell., 3d, alternately, hourly. 
November 9, noon. — Yery delirious ; blood coming from the 
mouth ; tongue red ; great thirst ; pulse jerking, feeble, about 80. 
Continue Bellad., 3d dil. 
Seven, p.m. — Much tossing ; tongue and lips dry and bleeding ; 
eyes staring ; hands cold ; pulse slow. 
Arsen., 3d dil. 
Nine, p.m. — Laborious breathing ; bluish, speechless ; pulse 75 ; 
seems insensible. 

* Laches., 6th, and Arsen., 3d, alternately every half-hour. 
10th, eight, a.m. — Hands and arms cold ; breathing laborious; 
lips and teeth covered with black sordes ; passed a very restless 
night ; no purging or vomiting ; cannot speak, but is sensible when 
spoken to. 

Bell., 3d dil. 
She died at six, a.m., of the following morning. 

Case XVIII. 

G. W., aged 47, a smith. — This man has had bowel complaint 
during the day for three days, but able to be at work. Sat up 
through the night of 3d November with his daughter, who died of 
cholera. At three, a.m., November 4th, the bowel complaint be- 
came worse ; went to his work at seven, a.m., taking for breakfast 
a piece of dry bread only ; felt sick on the road, and took a glass 



APPENDIX. 309 

of brandy, which he vomited, and the vomiting continued. We 
first saw him at nine, a.m. His tongue, skin, and breath were cold ; 
hands and nose livid ; eyes sunk, and surrounded with a dark circle ; 
expression ghastly ; voice husky, speech altered and indistinct ; 
pulse 140, weak. He was still anxious to go out to make arrange- 
ments about the funeral of his daughter. 

Arsenic, 3d dil., every quarter of an hour. 
Two, p.m. — He was in bed. Severe cramps in the legs and 
arms ; vomited five times, and purged seven times since last visit, 
dejections consisted of a large quantity of colourless fluid, containing 
flocculi ; pulse 120. 

Continue Arsen. 
Half-past five, p.m. — Vomited twice and purged once, fluid from 
bowels as before ; cramps less severe ; skin cold and clammy ; voice 
stronger ; pulse very weak, indistinct. 

Continue Arsen. 
Half-past nine, p.m. — Skin warm and moist ; no purging, vomit- 
ing, nor cramps ; great thirst ; pulse 88> full but weak. Took, 
about seven, p.m., a cupful of strong tea without milk, and eat a 
little bread — vomited neither. Voice much stronger, though his 
general appearance continues as before ; eyes sunk, half-open ; 
tongue furred, yellow, rather cold. 

Continue Arsen. every half-hour. 
5th November, quarter past twelve, a.m. — Bowels not moved ; 
no vomiting ; is restless, cannot fall asleep ; pulse 100, weak ; fea- 
tures contracted and hands shrivelled. 

Continue Arsen. 
Half-past nine, a.m. — Bowels moved soon after last visit, open 
since every quarter to half-hour, stools watery, of a dirty brick colour, 
small in quantity ; tenesmus, and ineffectual desire to urinate ; crav- 
ing for food ; countenance cadaverous ; feet, hands, and genitals 
blue, cold, and shrivelled ; face and lips cold ; tongue furred and 
cold ; breath warm ; pulse about 100, very weak, and scarcely per- 
ceptible ; less thirst. 

Nux vom., 3d dil. 
Ten, a.m. — In the same state. 

Mer. sol., 3d dil., and Canthar., 3d dil., 
alternately every half-hour. 
Eleven, a.m. — He took half a tea-cupful of bread and milk ; felt 






310 APPENDIX. 

fatigued and exhausted; respirations 32; pulse 100, more dis- 
tinct. 

Merc, cor., 3d, and Arsen., 3d dil., alternately. 

Twelve, noon. — No improvement ; breathless ; whole body cold ; 
pulse could not be felt at left wrist, very indistinct at the right. 
Continue medicine. 

Four, p.m. — Has been repeatedly seen, but no change; took arrow- 
root and milk twice ; was perfectly sensible till within ten minutes 
of his death. He was excited and wept when his daughters body 
was removed from the house at half-past four, p.m. 

He died at eight, p.m., 5th November. 

Case XIX. 

J. H., aged 38. — Intemperate habits. He was drinking to excess 
yesterday ; was seized at ten last night with vomiting and bowel 
complaint. We saw him first at half-past seven, a.m., 13th Novem- 
ber. Watery purging through the night, none since nine, a.m. ; 
urinated about an hour ago ; severe cramps in legs, arms, hands, and 
side ; body warm ; feet, hands, and face cold and livid ; pulse 106, 
small, weak, and indistinct, voice hoarse ; great thirst. 
Tinct. Camph. every five minutes. 
Ten, a.m. — Cramps in legs very severe; in other respects the 
same. 

Verat., 3d dil., and Cupr., 3d dil., 
alternately every quarter of an hour. 
Four, p.m. — Severe cramps in his legs, and frequent vomiting ; 
voice low and hoarse. 

Continue Yerat. 
14th, nine, a.m. — Vomiting continues every few minutes; bowel 
complaint abated ; no urine since yesterday afternoon ; great thirst 
and hiccough ; voice stronger ; pulse 76, small. 

Arsen., 3d dil., and Nux vom., 3d dil., 
alternately every half-hour. 
Ten, p.m. — Pulse 100, small; vomiting continues; tongue cover- 
ed with white fur, warm ; no pain at epigastrium ; slight cramps 
in the legs continue ; no urine passed. 

Canthar., 3d dil., every half-hour. 
15th, nine, a.m. — Slept well ; no urine past ; very little vomiting. 
Nux vom., 1st dil., every half-hour. 



^m 



APPENDIX. 311 

Twelve, noon. — Vomiting ceased; frequent ineffectual inclina- 
tion to urinate. 

Digital., 3d dil., every half-hour. 
Nine, p.m. — Still no urine passed ; one abundant bloody stool. 

Hellebor., 6th dil., every half-hour. 
1 6th, Ten, a.m. — No change. 
Ten, p.m. — Still no urine passed. 

17th, half-past eight, a.m.— Speaking indistinctly, he complains of 
pain in his chest— it sounds clear on percussion ; respirations 30 ; 
pulse 68 ; tongue dry; slight strabismus; no urine passed ; no pain 
or fulness over the pubis ; some difficulty in swallowing ; hands 
cold, shrivelled, livid. 

Stramon., 9th dil., every quarter of an hour. 
Three, p.m. — No improvement. 

Laches., 6th dil., every quarter of an hour. 
Nine, p.m. — He died a few minutes before this visit on 17th No- 
vember. 

We now pass from this dreary region of death to cases of re- 
covery*; and the cases which immediately follow constitute what we 
may call the Camphor group, as that remedy was mainly, if not 
solely, instrumental in rescuing almost all these patients. 

Case XX. 

Mrs. R., aged 43, previously in good health, was taken ill on the 
7th of October with cramps, &c, in the limbs, and vomiting. She 
was seen by an Allopathic physician on the 8th, and ordered lauda- 
num. When seen at eight o'clock, p.m., of the 9th, there was 
watery purging and much sickness. 

Veratr., 3d dil., a dose every half-hour. 

Twelve o'clock same night. — Her face is changed, being dark and 
sunken, the lips livid. She has fainted several times since last visit. 
Severe cramps in legs and stomach ; the pulse is small and quick. 
Camphor, a dose every few minutes. 

After four or five doses she fell asleep. 

10th, ten, a.m. — Is quite well, except slight headach and great 
exhaustion. 

Case XXL 
N. G., aged 21, a woman of intemperate habits. When walking 



312 APPENDIX. 

in the street to-night at half-past eleven, she was suddenly seized 
with severe cramps in the abdomen and legs. She would have fal- 
len had she not been supported and led into the house. We saw 
her first at twelve, p.m., on the 21st of October. Her abdomen was 
much swelled, she had severe cramps in the legs, shivering and cold- 
ness all over the body. Frequent muttering delirium, tossing about 
in the bed ; complains much of cold. Great desire to vomit, little 
ejected ; pulse slow and weak. 

Tinct. Camphor, in water every quarter of an hour. 

22d, one, a.m. — Much better. 

Verat., 3d dil., every half-hour. 

At the visit during the day, 2 2d October, found she was quite 
recovered. 

Case XXII. 

Mrs. T., aged 23, subject to dyspeptic attacks. She awoke this 
morning, 4th November, about six, a.m., with vertigo, noise in her 
ears, nausea, and pain in the epigastrium. We first saw her at 
seven, a.m., same day. She has vomited (three times in an hour) a 
large quantity of a greenish watery liquid. She complains of pain 
in the stomach and head. Skin cold; pulse 120, irregular; pain- 
ful dry retchings, no purging. 

Tinct. Camphor, every ten minutes. 

One, p.m. — No vomiting; occasional pains in her stomach and 
through her head ; taken no food ; rather thirsty. 

Continue Camph. every half-hour till relieved. 

5th November, noon. — Says she is better ; has some weight and 
pain in epigastrium, and feels a little nausea. 
Continue Camph. 

6th November, two, p.m. — She is sitting up, and is quite well. 

Case XXIII. 

Mrs. T., aged 24. — Has had a cold for several weeks, but been 
out every day visiting her husband, who is in the infirmary, labour- 
ing under phthisis. Is in circumstances of great poverty and des- 
titution, living chiefly on tea, which she takes twice a day. She 
was last night attending her uncle, whom she left dying of cholera 
between ten and eleven, p.m. She states that at that time she was 
seized with tremor over the whole body, which continues with chil- 
liness, vertigo, and noise in the head. She took whisky and pepper 



"!-?llift 



APPENDIX. 313 

an hour ago, and has been sick and retching frequently. During 
the last hour and a half she has had three copious, offensive, brown- 
ish liquid stools. We first saw her a little after midnight, 6th No- 
vember. She was then sitting up in bed, wrapped in blankets, her 
teeth chattering, rigors, and anxiously inquiring whether she would 
live ; her face, nose, lips, and tongue were cold ; skin dry, cold ; 
she began to retch during visit; pulse 108, feeble. 
Tinct. Camph., every ten minutes. 
Two, p.m. — Slept a little, is squeamish. 

Arsen., 3d dil., every half-hour. 
To have sago from the dispensary. 
7th November, noon. — Sitting up by the fireside quite well. 

Case XXIV. 

This case of recovery from the incipient stage finds its proper 
place here, although Camphor was not the remedy. 

J. N., a girl aged 22. — We first saw her at two, p.m., November 
1 3th. She was taken ill suddenly last night with vomiting of brown 
and slimy matter and violent pain in the legs, with much shivering, 
tongue warm; complains of pain in right side; pulse 120, small 
and weak. 

Arsen., 3d dil., every half-hour. 

14th November, nine, a.m. — Better; no vomiting or pain; pulse 
70 ; tongue clean ; no thirst. 

Continue Arsen. 

Two, p.m. — Continues free from pain ; feels comfortable and well. 

Case XXV. 

Mrs. C, aged 50. — Unwell for a week past. Has been in at- 
tendance on a woman who died of cholera this morning, November 
13th. She got Tinct. of Camph. We were sent for at nine, p.xM. 
She had violent empty vomiting ; pulse 1 20, small ; much pain in 
epigastrium and abdomen ; no purging. 

Aeon., 3d dil., Merc, cor., 1st dil., alternately every hour. 

14th November, nine, a.m. — Much better; no vomiting; pulse 
natural. 

Continue Merc. cor. 

Ten, p.m. — Continues better. To have a supply of sago. 

16th November, noon. — She continues quite well. 



314 APPENDIX. 

Case XXVI. 

E. M., a girl, aged 21. — A stranger, and given shelter in the 
house where she is. She states that she took spirits during the day 
on account of pain in the epigastrium, and felt tolerably well till 
about six, p.m., when, after taking some tea, she began to vomit ; 
has since vomited repeatedly a brown watery liquid. She had 
severe pain in the stomach and through the head, was taciturn, 
fainted before she was put to bed, and had cramps in the abdo- 
minal muscles. The muscular contractions were irregular, and 
confined chiefly to the left side of the abdominal parietes. We 
first saw her at half-past eleven, p.m., 15th November. She was 
lying quietly on her back, but soon began to toss about, kick, and 
strike with her arms, and roll her head from side to side, sobbing. 
She bent herself forward involuntarily with a scream, and then fell 
powerless. The abdominal muscles on the left side were raised 
and hard, swelled on that side as in pregnancy ; sound, on percus- 
sion, hollow. She has had several paroxysms of a similar nature 
since six this evening. She says she has no pain except headach 
during the paroxysm. Her skin is cold and dry; pulse 92. 
Tinct. Camph. every ten minutes. 

16th November, noon. — Is better ; sitting up dressed. 

Six, p.m. — Is up, cheerful, and quite well. 

Case XXVII. 
~M. L., a girl, aged 9. — Nine cases of cholera have occurred in the 
flat where this patient lives ; both her mother and sister had it. We 
saw her first at half-past eight, p.m., November 19th. She was 
suddenly seized, about an hour ago, with violent pain in the abdo- 
men, and empty retching, chattering of the teeth, coldness of surface ; 
anxious, uneasy expression of face ; restless ; voice feeble and moan- 
ing ; pulse 1 30 ; no purging ; very great thirst ; coldness of breath. 
Tinct. of Camph. every five minutes. 
Half-past ten, p.m. — After five or six doses she fell asleep. Found 
her asleep. Pulse 90 ; expression improved ; respiration natural ; 
passed urine. 

Continue Camph. 
20th November, seven, a.m. — She has slept calmly since last visit. 
Pulse 100; aspect natural. 
Nine, a.m. — Much the same. 

Bellad., 3d dil., every two hours. 



APPENDIX. 315 

Nine, p.m. — Sleeping ; no stool ; urinated. 

21st November, nine, a.m. — Slept well, looks better, and seems 
quite well. 

2 2d November. — Continuing well. 

Case XXVIII. 

C. P., a woman, aged 27. — Her father has been ill of cholera, 
and she has attended him for the last two days ; during this time she 
has taken scarcely any food, and has had no rest. While sitting at 
the fireside last night, about ten o'clock, she fainted and was put to 
bed. She felt cold, and had some brandy and water ; after this she 
shook, and her teeth chattered. Vomiting began about eleven, p.m. 
She had cramps, severe pain in the epigastrium, and pains over the 
whole body, which made her cry out and be restless. She was first 
seen at half-past two, a.m., November 21st. She was roaring from 
cramps all over the body, which made her retch ; eyes wide open, 
expression restless ; complained of coldness in her bowels ; face, lips, 
and hands cold and pale ; tongue warm ; pulse 104, unsteady. 
Tinct. Camph. every quarter of an hour. 

Nine, a.m. — Fell asleep after taking medicine ; slept till eight, 
a.m. Pulse 100; no vomiting or purging ; great general pain ; no 
urine passed. 

Four, p.m. — Found in a deep sleep ; pulse 96, hard ; perspiration, 
warm on the chest, cold on the forehead ; no urine passed. 
Continue Camph. 

22d November, nine, a.m. — Was up, sitting by the fire ; com- 
plains of general uneasiness ; pulse quick. 

Nux vom., 3d dil., every two hours. 

23d November, nine, a.m. — Sitting up ; complains much of gid- 
diness; perspired freely through the night; bowels costive; pulse 62. 
Continue Camph. occasionally. 

One, p.m. — Doing well ; urine and bowels natural. 

25th November, three, p.m. — Continuing quite well. 

Case XXIX. 
A woman, aged 48.— Had diarrhoea three weeks ago for eleven 
days, but has been in good health since. Took dinner at two, p.m., 
after which her bowels were moved once, and she was directly after- 
wards seized with vomiting, first watery fluid, and then her dinner. 
Seen first at four, p.m., October 24, when she was cramped in the 



316 



APPENDIX. 



legs and toes ; was in bed, roaring furiously from pain in the stomach, 
and vomiting a large quantity of whitish liquid, with painful retch- 
ings. After the vomiting had ceased, the pain in the stomach became 
excruciating, followed by the same train of symptoms; pulse slow 
and faint ; skin cold and clammy ; hands and feet cramped. Camph. 
every now and then was given. After an interval of a quarter of 
an hour she vomited the white characteristic cholera liquid once more, 
then became cheerful, wiped her face, and exclaimed, " Now, I am 
better;" was very thirsty. Camph. now and then till quite warm. 
Seen at nine, p.m. ; was better, except occasionally cramped in the 
tougue and eyelids. Visited next day; quite well. 

Case XXX. 
R. G., aged 53. — A miserable house, lying on a shake-down in a 
corner without covering. Intemperate ; drinking on Sunday. Was 
attacked in his own house at half-past ten, p.m., of the 27th Novem- 
ber. Seen first 28th November, seven, p.m. Has been purging 
frequently thin whitish liquid, involuntarily ; has vomited two or 
three times, frequent dry retching ; cramps in knees, thighs, and 
calves of the legs ; great and incessant thirst ; heart's action regu- 
lar but vyi.y weak ; pulse 70, small and weak ; general coldness; 
tongue cold ; voice tolerably good ; no urine for 24 hours. 
Camphor every ten minutes. 
Ten, p.m. — No vomiting nor purging. 

Continue. 
29th, ten, a.m. — Slept well ; no vomiting nor purging; urinated 
a little last night ; thirst continues. 

Continue. 
Twelve, p.m. — Purged twice through the day ; faeces yellow ; 
urinating freely ; still thirsty ; complains of hunger. 
30th. — Purging ceased ; feels well. 

Case XXXI. 

J. H., aged 64. — An occasional drinker. In delicate health 
has had bowel complaint for a week past, it stopped suddenly yes- 
terday, but recommenced in the forenoon ; began to vomit about 
three, p.m., of the 1st of December. First seen 2d December, one, 
A M. ; urinated two or three minutes ago ; purging, stools like rice 
water, very foetid ; cramps in toes ; great thirst ; face inclined to 
be cold ; tongue coldish, furred ; pulse 106, weak. 



APPENDIX. 317 

Camphor every ten minutes for three hours, 
then Mercurius, 3d, hourly. 
Noon. — Bowels once moved, stools the same character as before ; 
no urine, though a desire to pass it; pulse 82 ; no cramps. 
Veratrum hourly, Camphor occasionally. 
Eleven, p.m. — One stool ; continues better ; no cramps ; uri- 
nated this afternoon. 

Continue. 
3d, noon. — Had a good night; urinated; passed a bilious stool this 
morning, and is hungry. 

Case XXXII. 

C. L., aged 44. — Has been attending a case of cholera. Of such 
dissipated habits, that her family who are in respectable circum- 
stances cannot have her with them. About three, p.m., 6th Decem- 
ber she was seized. First seen 7th December, one, a.m. Feeling 
of coldness over the whole body ; violent shiverings and cramps ; 
constant sickness, vomited seven or eight times since seizure ; 
purging several times (dejections not seen) ; urinated a little time 
ago ; great thirst ; heart's action weak ; pulse 74, weak ; skin cold, 
shivering violently ; tongue cold ; giddy. 

Camphor every quarter of an hour. 

Eight, a.m. — Pulse 100 ; hands and tongue warm ; great pain in 
epigastrium, increased on pressure ; vomiting ; no purging since last 
visit; cramps continue, but less severe ; giddiness; thirst and head- 
ach ; urinated about an hour ago ; constant nausea ; slept none ; 
still shivering during the cramps. 

Ipecacuan., 3d, hourly. 

Six, p.m. — Great thirst; much pain in the belly, with continual 
eructations; pulse 120, weak. 

Continue alternately with Aconite. 

8th, eight, a.m. — Some pain during the night ; feels better this 
morning ; temperature of the skin natural. 

Case XXXIII. 

J. Mc, aged 19. — Two cases of cholera occurred previously in 

this house. A sober lad. Was quite well all day and went to bed 

well. On 8th December, about ten, p.m., he was suddenly seized 

with cramps all over the body, especially in the arms, legs, and 



318 APPENDIX. 

stomach, with great stiffness both of arms and legs ; could scarcely 
move and not walk without support ; nausea and dry retching ; no 
purging ; has not urinated since rising in the morning ; has had 
laudanum and whisky, and pepper, which seemed to make him worse. 
First seen at half-past eleven, p.m. Found him with his feet in 
warm water, bellowing furiously ; would not tell at first where his 
pain was ; face flushed ; clammy perspiration ; skin hot ; pulse 
164, pretty full; shaking and shivering from pain; epigastrium 
tender on pressure ; great thirst ; face dark ; very anxious. 
Camphor every five minutes. 

After the fourth dose the severity of the pain began to diminish, 
and he passed fully lb. ij. of limpid urine ; felt easier, though still 
moaning loudly. 

Continue. 

9th, six, a.m. — Cramps continued till four, a.m., when he fell 
asleep ; slept till now, and he is quite free from pain ; urinated at 
four, a.m. ; no motion of bowels ; pulse 76, regular ; skin of natural 
temperature. 

10th. — Is free from pain ; bowels regular ; urinating freely. 

Five, p.m. — Relapsed after taking soup and rabbit to dinner ; 
pains as before, but not so violent ; no urine since morning. 
Repeat Camphor. 

Nine, p.m. — Pains reported less severe, but constant sharp pain 
all through body. 

Cuprum Aceticum, 3d, every hour. 

] 1th, half-past eight, a.m. — Urinated twice : bowels thrice 
moved ; pulse 72, natural ; tongue dry ; pain over the whole ab- 
domen, increased on pressure ; great thirst ; no cramps after eight 
last night ; some giddiness still remaining. 

China, 3d, thrice a day. 

Two, p.m. — Reported much better. 

1 2th. — Found up supping porridge ; says he is well. 

Case XXXIV. 

Mrs. D., aged 56. — Has been a tippler for years, but her son says 
she has been tolerably sober for three months. Admits she has 
had whisky to-day. Has had two glasses just before visit ; is talk- 
ative, afraid of the doctor, and in great terror lest she should be re- 
moved to hospital. Unwilling to give an account of her state. 
States that she has felt giddy and queer all day ; passed no urine 



APPENDIX. 319 

since yesterday. Went to bed apparently pretty well. Was 
seized at ten, p.m., 10th December, with severe cramps in the sto- 
mach and toes, she screamed violently and rolled about the floor. 
When seen at half-past ten, p.m., her face was flushed and haggard ; 
her eyes watery ; retching and vomiting frothy liquid ; legs cold ; 
face and tongue warm, white ; pulse 100 ; feels cold and shivering ; 
has great thirst : no bowel complaint. 

Camphor in hot- water every half-hour. 
11th, half-past nine, a.m. — Pains severe in epigastrium; tongue 
exsanguined ; pulse 84 ; retching; no purging; urinated once. 
Nux, 3d, hourly. 
Four, p.m. — Pains much less severe ; no purging ; still sora 
retching, but lying quietly ; skin warm. 

Continue. 
1 2th, eight, a.m. — Yomited some glairy mucus yesterday after- 
noon ; slept well ; pulse 72 ; pain in epigastrium increased on pres- 
sure ; tongue white ; urinated freely ; great thirst ; nausea. 
Antimonium crudum, 3d, hourly. 
13th, half-past eight, a.m. — Some sickness; pulse 88, strong; 
still pain at epigastrium ; urinated ; great thirst ; no vomiting ; 
surface warm ; tongue moist and clean. 

Continue. 
14th. — Sitting up taking breakfast; feels well. 

Case XXXV. 

J. R., aged 4. — Was quite well to-day, 11th December. While 
sitting playing, about three, p.m., she cried out suddenly of her 
bowels, and when relieving them began to vomit white frothy fluid. 
She became stiff, cold, and blue, especially below the eyes ; com- 
plained of pain in her belly and fainted ; was given some hot 
whisky toddy, after which she became warmer ; no urine since fore- 
noon. Seen at nine, p.m., and ordered 

Camphor half-hourly. 

] 2th, nine, a.m. — After a few doses of Camphor, went to sleep ; 
slept well and perspired ; urinated this morning. Is up playing, 
and seems well. 

Case XXXYI. 

Mrs. D., aged 38. — A dirty, crowded house. Was quite well all 
day, ] 6th December. About eight, p.m., took tea and bread ; im- 



'c$§m%t 



320 APPENDIX. 

mediately afterwards, feeling hungry, took a piece of roasted kid- 
ney ; felt sick and vomited ; took tincture of rhubarb and opium, 
which was vomited immediately. First seen at half-past eleven, 
p.m. Was vomiting every five or six minutes bloody fluid, twice 
with coagula, with severe retching. Was sitting up in bed cold, 
ghastly, and pulseless. Great soreness from the middle of the ster- 
num to the epigastrium, increased on pressure ; thirst ; breathing 
much oppressed ; suppression of urine. 

The sickness was relieved by drinking warm water containing a 
little spirit of camphor. During the next half-hour, she vomited 
seven times the same bloody-looking fluid ; the cramps were less 
severe. 

Continue Camphor. 

17th, ten, a.m. — During the two hours after visit, she vo- 
mited four times the same bloody fluid, and since three this morning, 
thrice a brownish, yellow fluid ; pain in epigastrium gone ; slept 
a little ; bowels open, urinated ; is warm ; pulse 68 ; still com- 
plains of nausea ; less thirst ; tongue pale and warm. 

Continue. 

18th, ten, a.m. — Has not vomited nor purged since twelve last 
night ; feels sick ; pulse 88, weak ; skin cool. 

Continue. 

19th. — Was out; the children said their mother was well. 

Case XXXVII. 

J. T., aged eleven. — Has been purging and vomiting occasionally 
since Sunday last. Become much worse yesterday afternoon, 3d 
January. First visited 4th January, four, a.m. Had watery purg- 
ing and vomiting; skin cold, hands blue, tongue ice-cold ; quite 
pulseless ; looks dejected ; great thirst ; says he has no pain. 
Camphor every ten minutes. 

Eleven, a.m. — Two stools ; no vomiting ; skin and tongue warm ; 
urinated this morning. 

Arsenic, 3d, half-hourly. 

Ten, p.m. — Bowels three times moved ; urinated freely ; skin 
warm ; pulse 94 ; sleeping quietly ; felt hungry. 
Omit medicine. 

5th, eleven, a.m. — Slept well through the night ; crying for food 
this morning. 

8th. — Running about quite well. 



"^y^'f^i'fss^"-^.K}^mw-p9 



^W^^^^^^m 



APPENDIX. 321 

Case XXXVIII. 
M. D., a girl, aged eleven.— A sister she nursed died of cholera 
on Wednesday. Yesterday she seemed dull, but her friends thought 
she was grieving for the child. To-day, 5th January, at seven, 
a.m., began to vomit and purge. First seen at eight, p.m. Was 
vomiting frothy matter; had watery purging; no cramps; great 
thirst ; skm cold ; face, lips, and nose blue ; no pulse ; urinated a 
little time ago ; complains of pain in the head. 

Camphor every ten minutes. 
Ten, p.m. — Since last visit, vomited twice ; no purging. 
Continue. 
^ 6th.— Vomited twice to-day; no purging; urinated three 
times ; skin warm ; pulse 112; thirst still great ; dark circles round 
eyes. 

Arsenic, 3d, every hour. 
7th.— No vomiting; urinated three times; bowels once moved; 
feces dark and liquid; less thirst; pulse 84; felt hungry; this 
afternoon had a few spoonfuls of sago, which were not vomited. 
Continue every two hours. 
8th.— Had a good night; no purging; urinated freely; feels 
oetter. 

Continue. 
9th.— Slept well, feels well, and is hungry. 

Case XXXIX. 

^ Mr. K., aged twenty-six.— Had nausea and vomiting during the 
night, with cramps in the abdomen and pains in the epigastrium. 
Sewed at five, a.m., 9th January; first seen ten, a.m. Vomiting 
large quantities of whitish watery matter ; purged once very pro- 
fusely ; pain in abdomen and epigastrium ; shaking and chattering 
his teeth ; great thirst ; breath cool ; pulse quick and weak ; skin 
cold ; no urine since early in the morning. 

Camphor every quarter of an hour. 

Three, p.m.— Still sick ; vomited twice, but free from pain ; pulse 
fuller and regular. 

Ipecacuanha, hourly. 
10th, ten, a.m.— Very thirsty; vomited this morning watery 
liquid m abundance ; frontal headach. 

Nux Vomica, 3, every two hours. 
X 



322 APPENDIX. 

Nine, p.m. — Shaking involuntarily ; skin warmer ; thirsty. 

Continue. 
11th. — Much better ; to have arrow-root. 
12th. — Continuing to improve. 
13th. — Up, sitting at fireside ; feels hungry. 

Case XL. 

A. M., a girl aged twenty. — Small, dirty, very smoky house. Has 
had bowel complaint for two or three days ; catamenia ceased yes- 
terday. Seized 14th January, four, p.m. First seen, nine, p.m. 
About four, bowel complaint became very severe, with vomiting ; 
evacuations came in sudden gushes, described as of green liquid. At 
six, p.m., severe pain in bowels began, came on in fits, especially 
severe immediately before purging ; she had been screaming and toss- 
ing about during the pain ; no cramps in limbs. Has taken pepper- 
mint and laudanum, but had an attack since ; passed urine at four, 
p.m.; great thirst; pulse 104, weak; hands and arms cold; face 
cool, dusky ; tongue white, furred, cool. 

Camphor every quarter of an hour. 
5th, ten, a.m. — Vomiting and purging stopped soon after visit 
last night ; slept a little ; feels better this morning ; pulse 92 ; skin 
warm ; tongue still furred ; less thirst ; severe headach, attributed 
to a blow which she received on Saturday. 

Mercurius, 3d, every four hours. 
16th, eight, a.m. — Had return of sickness last night, which was 
checked by a few doses of camphor. Is up, working in the house ; 
feels well. 

Case XLT. ^ 

Mrs. S., aged 43. — Passed through Glasgow, and passed a night 
there seven days ago. Was suddenly seized at four this afternoon, 
15th January. First seen at five, p.m. Watery purging and vomit- 
ing ; cramps in the epigastrium ; great thirst ; no pulse perceptible ; 
extremities cold ; face haggard ; eyes sunk ; suppression of urine. 
Camphor every ten minutes. 
Eight, p.m. — Better ; pulse 100 ; passed urine ; stools fewer and 
more faeculent. 

Aconite, 3, and Mercurius, 3, alternately hourly. 

16tb, eleven, a.m. — Much better; no stool; pain at epigastrium. 

Nux, 3, every two hours. 



m*m*mm*m*mmmmmm 



APPENDIX. 323 

17th. — Quite well, except slight pain at epigastrium, and weak- 
ness. 

Case XLII. 

Mrs. P., aged 40. — Attended her husband who had cholera, (Case 
LXIL) Has not been well for some weeks. Was out late last night 
in the rain ; shivered before going to bed. Began to purge and 
vomit this morning, 23d January, about two o'clock ; first seen at 
eleven, a.m. Vomiting frequent, of everything taken, and of bitter 
liquid ; purging ; stools watery, with whitish flakes ; cramps in both 
popliteal spaces ; great thirst ; coldness ; difficulty of breathing ; 
pulse irregular, small ; the cough which she has had for some time 
has left her. 

Camphor occasionally, and Mercurius, 3, every hour. 

Five, p.m. — Much better ; is warmer ; no nausea nor purging 
since she got the powders ; still thirsty ; has urinated. 

Continue. 

24th, eleven, a.m. — Was found asleep, and breathing heavily. The 
cough has returned. 

Bryonia, 3, every two hours. 

25th. — Bowels not moved since last night ; pulse 84, full ; still 
coughing. 

Continue. 

26th. — Much better ; up. attending to her house. 

Case XLIII. 

J. C, aged 42. — Was cramped last night in epigastrium ; took 
brandy and laudanum on going to bed. The pain became worse 
this morning, 24th January, between two and three ; took laudanum 
again ; it made him sick, and he vomited several times bitter white 
watery liquid profusely. Diarrhoea then set in. First seen at three, 
p.m. Was cold and sallow ; great thirst ; pulse intermittent ; 
tongue furred. 

Camphor every ten minutes, 
and then Mercurius, 3, every half-hour. 
Nine, p.m. — Much better; skin dry and warm; pulse 96, re- 
gular ; less thirst ; bowels moved twice ; stools copious and thin ; 
no urine. 

Continue. 



324 APPENDIX. 

25th, eleven, a.m. — Urinated this morning ; bowels opened once ; 
slept well last night, and perspired a little. 

Continue. 
26th. — Better still ; thirsty and sick after drinking water. 

Continue. 
27th. — Better ; bowels not open ; urinated three times since last 
visit. 

29th. — Says he is quite well ; is hungry. 

The following cases (all but the first) recovered from fully formed 
cholera. 

Case XLIV.* 

E. G., a woman aged 35. — Habits temperate ; previous health 
good. Was quite well last night. She was taken ill at three this 
morning, 23d October, with vomiting and purging. We saw her 
first at three, p.m., the same day. Surface of the body cold ; an ex- 
pression of terror on her face ; tongue and breath cold ; no pulse ; 
moaning from cramps; complained much of pain at breast. She 
had three or four doses of Arsenic, 3d dil., without any benefit. 

Five, p.m. — Acid Hydrocyanic, 3d dil., every five minutes. 

In about half an hour she exclaimed, " God be thanked, my heart 
is getting better." Pulse perceptible, surface warmer. 
.Arsen., 3d dil., every quarter of an hour. 

Eight, p.m. — Vomited and purged once ; no cramps ; complains 
much of pain in sides and back ; surface warm, and perspiring ; 
very thirsty. 

Continue Arsenic. 

24th October, six, a.m. — Soreness of body, especially of abdomen ; 
was easier from twelve to three. Pulse not perceptible. 
Continue Arsenic. 

Half-past eight, a.m. — In the same state. 
Continue Arsen. 

Three, p.m. — Pulse 120 ,* vomited once ; tongue cold ; no cramps. 

* This is a case of only partial recovery, for she afterwards died in the In- 
firmary, and of course it does not appear among the recoveries in the table ; but 
as it is interesting for various reasons, we have thought it advisable to include 
it in our reported cases. She was removed at the express desire of the lodging- 
house keeper, and probably suffered in consequence of the removal. 



iwiiiifiwiwiwiiw'w^ 



APPENDIX. 325 

Continue Arsen. 
Five, p.m. — Stools dark-red, with a fasculent smell ; complains 
much of thirst and pain in the abdomen. 

Merc, cor., 2d dil., half-hourly. 
Nine, p.m. — Pulse 90 ; great pain in abdomen. Being a lodger 
merely, and not comfortably attended to, at the request of her 
friends she was sent to the Infirmary. 

Case XLV. 

Mrs. M'D., aged 28, married nine years, has no family, of 
hemorrhagic diathesis. She has been weakened by too frequent 
and too copious catamenia. At the end of the last catamenial period, 
three days ago, diarrhoea came on, which continues. She began to 
vomit this morning, and continued to do so till six, p.m., when 
uterine haemorrhage commenced ; she got very weak and took brandy 
at seven, p.m., which was instantly vomited. We saw her first on 
28th October, at half-past eight, p.m., she was sitting in bed, melan- 
choly and afraid of instant death; pulse 128, small; skin exces- 
sively cold, with cold perspiration on nose and forehead. Complains 
of being very sick ; cold, particularly in the bowels, and thirsty ; 
urine suppressed since last night ; feels very weak, and says she 
cannot breathe when lying, and cramps come on in legs. She is 
sallow and ghastly in appearance. 

Secale, 1st dil., every few minutes, 
to be followed in half an hour by Verat., 3d dil., 
every quarter of an hour. 
Twelve, p.m. — She has had only one attack of vomiting, along 
with purging without cramps. 

To have her feet in warm bath. Continue Verat. 
29th, eight, a.m. — Much better ; no vomiting or purging since 
midnight ; felt sick at four, a.m., and took a few doses of medicine ; 
afterwards fell asleep and perspired freely ; pulse, when lying, 92 ; 
is irresistibly thirsty. 

Secale every half-hour. 
Twelve, noon. — Better ; no vomiting or purging. 
Nine, p.m. — Has perspired almost the whole day ; skin warm ; 
pulse 80, firm and full ; no purging or vomiting ; had some slight 
cramps in the legs twice since last visit. 

Continue. 



326 APPENDIX. 

30th, eleven, a.m. — Much better ; bowels not moved. 

Continue Secale. 
31st, six, p.m. — Better; bowels not moved. 
Nov. 2d, ten, p.m. — Says she is now quite well. 

Case XLYI. 

M. D., a woman of 23 years of age, and was seen first in the house 
whence her mother had been removed to the Infirmary suffering 
from cholera, of which she died. Another woman died of cholera in 
the same flat. She was seen first at one, p.m., of the 29th of Oc- 
tober, the expression of countenance dejected; face of a bluish 
colour and cold ; frequent retching ; copious brownish stools ; pulse 
128, weak; feels very weak and chilly. 

Arsen., 3d dil., every hour. 

October 30th, half-past ten, a.m. — After four doses of Arsen. be- 
gan to perspire ; bowels only twice moved siuce last visit ; pulse 100. 
To continue Arsen., every two hours. 

31st October, five, p.m. — Pulse 92, soft ; bowels not moved. Was 
ordered sago, and to continue medicine. 

1st November. — Found her up, and quite well. 

Case XL VII. 

Mrs. B., aged 32, a widow. — Was drinking to excess on Saturday 
last ; yesterday at six, a.m., began to vomit, first bilious matter, then 
whatever taken. We saw her first at five, a.m., November 13. 
Skin warm, except hands and arms, which are cold ; colour natural ; 
bowels costive for two days ; pain in chest and palpitation of the 
heart ; tongue warm ; burning in stomach ; no cramps ; vomiting 
very urgent ; great thirst. Has had salts and brandy ; pulse about 
90, small and indistinct. 

Tinct. Camph. every ten minutes. 

Six, a.m. — No change. 
Verat., 3d dil., Arsen., 3d dil., alternately every half-hour. 

One, p.m. — Constant watery vomiting; no cramps ; pulse 120. 
Continue medicine. 

Eight, p.m. — Vomiting continues ; urgent thirst. 
Continue Verat. 

1 4th November, one, a.m. — Constant vomiting ; contrary to or- 
ders has been getting tea and spirits. 



aw^i^ap^ 



APPENDIX. 327 

Half-past nine, a.m. — Vomiting continues, of water with dark 
flocculi ; pulse 120, small ; ineffectual desire to urinate ; very giddy 
when she tries to rise ; much pain in epigastrium. 
Nux Vom., 1st dil., half-hourly. 

Five, p.m. — Rather better. Continue medicine. 

Half-past nine, p.m. — No vomiting; pulse 112, tolerably strong. 

15th, nine, a.m. — Better; has taken castor oil; pulse 80; urinating. 
Continue Nux. To have arrow-root. 

Noon. — Pulse good ; bowels open ; dejections black. 

17th, half-past eight, a.m. — Vomited three times during the 
night ; feels better. 

18th. — Complaining of pain in stomach and flatulence ; pulse 80; 
skin warm, soft ; bowels costive. 

Tinct. Camph. occasionally. 

21st. — Is up and quite well. 

Case XLVIII. 

F. R., aged 27. — Delicate and subject to diarrhoea. She has 
been three days under the action of Allopathic remedies. We saw 
her first, November 16, eleven, a.m. She was lying on her right 
side; countenance pale, haggard, and dejected; pain in the head, 
limbs, and abdomen, below umbilicus ; purging and vomiting white 
watery fluid; pulse 120, weak; skin cold; tongue furred; great 
thirst. 

Tinct. Camph. half -hourly. 
Three, p.m. — Vomiting ceased, is sick ; bowels opened twice ; pain 
in the abdomen ; pulse 100. 

Merc, sol., 3d, every hour. 
Eleven, p.m. — Much better ; vomited and purged only once ; 
pains in abdomen less frequent and severe. 
Continue Merc. 
17th, eleven, a.m. — No purging nor vomiting; pulse 80; skin 
warm ; perspired through the night. 

Continue Merc. 
18th. — Slept well ; no pain ; tongue cleaning. 
19th. — Is quite well. 

Case XLIX. 
W. C, aged 56, — He has had diarrhoea for three days. Since 



328 APPENDIX. 

five o'clock last night, has been vomiting and purging ; cramps since 
four this morning. Has had brandy and four opium pills, produc- 
tive of no benefit. We saw him first, November 18, half-past two, 
p.m. — He was lying on his back speechless; pulse 108; skin warm 
and dry ; lower jaw hanging down ; occasional startiug ; when 
roused spoke in a whisper, and asked for drink ; frequent purging 
and vomiting of watery fluid. 

Tinct. Camph. now and then, Merc, sol., 3d, every hour. 

19th November, ten, a.m. — No vomiting, purging, nor cramps 
since ten last night ; slept pretty well ; no urine, passed since yester- 
day ; skin warm ; pulse 96, feeble ; drowsy, wakes occasionally 
with desire to vomit. 

Continue Camph. and Merc. 

20th, half-past six, a.m. — Rested well all night ; urinated through 
the night ; skin natural ; great thirst ; feels better. 
Continue Camph. and Merc. 

21st, nine, a.m. — Was dressed and feels well. 

Case L. 

Mrs. C, aged forty-five. — Exhausted by attending on her hus- 
band who has been ill of cholera, and want of food. She has had 
trembling of the body, and chattering of the teeth all day, with 
purging, watery dejections passing from her bowels in gushes ; feels 
very sick ; has a desire to lie down ; has passed no urine during the 
day. We saw her first at ten, p.m. — Skin cold ; pulse 1 1 2, weak, 
with marked choleric expression of countenance. 

Tinct. Camph. every now and then, 
Merc, sol., 3d dil., at bed- time. 

1 9th November, ten, a.m. — Much better, is up ; no purging during 
the night ; slept a little ; much headach ; pulse 92, firm. 

20th, half-past six, a.m. — Reported quite well. She was out 
when visit was paid. 

Case LI. 

A. R., aged ten. — He has been confined to bed for more than six 
months with morbus coxarius, and is much emaciated ; subject to 
diarrhoea for some months. This morning frequent purging and 
vomiting. We first saw him 20th November, at one, p.m. — Skin 



■^ #»1^ 



APPENDIX. 329 

cold ; eyes sunk ; dark sallow countenance ; eyes turned up, half- 
shut when apparently asleep ; purging and vomiting watery floccu- 
lent liquid ; breathing languid ,* pulse 120, weak. 

Tinct. Camph. now and then, Merc, sol., 3d dil., every hour. 
21st noon. — Much better; bowels moved only once. 

Continue Camph. and Merc. sol. 
2 2d. — Took some food, and beer when thirsty — began to vomit 
and purge. 

23d. — Vomiting and purging continue ; nearly pulseless. 

Continue Camph. and Merc. sol. 
24th. — Free from pain in haunch ; eyes turned up ; speechless. 

Continue Merc. 
25th. — No vomiting and purging ; exhausted and thirsty ; pulse 
getting stronger. 

26th. — No vomiting ; bowels not moved for two days. 

Continue Merc. 
27th. — Has taken some food ; bowels not moved ; pulse 84, full ; 
begins to cry again from pain in the hip. 

Case LII. 

M. A., a woman, aged forty-five. — Her only child died of cholera 
last night. She is of intemperate habits, and has been drinking to ex- 
cess for a day or two, and has had bowel complaint for a few days. 
Between three and four this morning began to vomit. We first saw 
her at half-past nine, p.m., 2 2d November. — She had frequent vo- 
miting of a clear watery fluid ; purging, stools reported as consist- 
ing of brownish fluid mixed with blood ; urinated half an hour ago ; 
frequent cramps in feet and hands ; pulse 74 ; face cold ; extremi- 
ties at times cold ; countenance dusky, expressive of great anxiety ; 
smells strongly of spirits. 

Tinct. Camph., every quarter of an hour. 

23d, half-past eight, a.m. — Pulse 120, small ; vomited once, and 
no purging since last visit ; skin warm ; she has been very restless 
through the night ; passed a good deal of wind ; urinated abundantly 
this morning ; great thirst ; complains much of weakness. 
Continue Camph. 

Twelve, noon. — Vomiting a good deal for the last two hours ; com- 
plains of soreness over the stomach and bowels ; extremities cold. 
Arsen., 3d dil., every hour. 



330 APPENDIX. 

Eight, p.m. — General heat good ; cramps continue in legs. 

Continue Arsen. 
25th, ten, a.m. — Bowels regular; pulse natural; urinating 
freely ; sick and vomiting when she moves. 
Ipecac, 3d dil., hourly. 
26th, two, p.m. — Found sitting up drinking tea; says she is 
quite well. 

The following case occurred in Portobelio : — 

Case LIII. 

A girl, aged 13, was seen at one o'clock, p.m., on the 29th of Oc- 
tober. No previous bowel complaint. Passed no urine since last 
night. At four this morning seized with vomiting and purging of 
white fluid every few minutes, and cramps in legs and arms. 

First seen at one, p.m. — Surface of the body cold ; face livid ; eyes 
deeply sunk, surrounded with dark circles ; tongue pale, cold, and 
flabby; breath cold; voice hoarse and querulous; expression anxious; 
quite pulseless ; restless ; vomiting clear, watery fluid ; evacuations 
described white and foetid ; complains of cutting pain in right side 
catching breath. Epigastrium painful on pressure. 
Camph. at intervals of five minutes. 
In ten minutes pulse quite perceptible ; tongue and lips very cold ; 
no vomiting or purging. 

1-20. — Vomited once; much pain in epigastrium. 

Cupr., 3d. 
1-40. — Pain abated ; vomited once. 

Continue alternately with Verat. 
2-45. — Vomited once ; burning pain in belly, and desire to sleep. 

Arsen., 3d. 
3. — Some cramps in hands ; pain catching breath ; pulse very 
feeble. 

Continue Arsen., every quarter of an hour. 
3-10. — Pain in bowels increased; 

Cupr., 3d. 
3-25. — Pain relieved ; once vomiting. 
Arsen., 3d. 
5-45. — Has had three or four attacks of vomiting ; pulse small, 



.,.**.,*** ,, 9»]^!^^^^l^ > f>f^^09^ ^ 



APPENDIX. 331 

rapid ; tongue and skin warmer ; urgent thirst ; burning heat in 
stomach ; moaning. 

Continue Arsen., 3d. 
30th. — Restless through night ; great thirst ; vomiting continues ; 
skin and tongue warm ; pulse 120, small ; bowels once moved, re- 
ported very foetid ; ineffectual desire to relieve bowels. 
Continue Arsen., 3d. 
Two, p.m. — One copious fcetid stool ; passed a little urine ; skin 
warm ; complains of hunger, and has no pain. 

Five, p.m. — Pulse 120; continues free from pain. 
Continue Arsen., 3d, 
taken in a table-spoonful of gruel every second hour. 
1st November. — Much better. 

Case LIY. 

Mrs. M'K., aged 56. — A dirty house. She has been purging 
three or four days ; seized 22d November, four, a.m. First seen at 
seven, a.m. She was purging white watery fluid ; vomiting every- 
thing taken ; cramps in legs and arms ; great thirst ; oppressed 
breathing; pulse 128, weak; skin cold and dry ; lips blue; tongue 
cold ; puffed countenance ; suppression of urine. 

Arsenic, 3d, every quarter of an hour. 
Noon. — No vomiting ; bowels moved once. 
Continue half-hourly. 
23d, eleven, a.m. — Vomited twice, and bowels moved three 
times ; great thirst. 

Veratrum, 3, and Arsenicum, 3, every quarter of an hour. 
24th, ten, a.m. — No vomiting nor purging, but sick and thirsty ; 
pulse 96, fuller. 

Continue. 
25th, three, p.m. — Much better ; feels hungry. 
26th. — Is up, and says she is quite well. 

Case LV. 

J. R., aged 31, seized 24th November, two, a.m. — First seen, 
eight, p.m. Very poor, the bed with scarcely any covering. On 
Monday got wet feet, and has been cold and shivering with bowel 
complaint since. Vomiting began at two this morning, and con- 
tinues, only however after drinking ; constant inclination to vomit; 



332 APPENDIX. 

purging, dejections described as of colourless water ; urinated at 
nine, a.m. ; severe cramps through the day in legs ; voice hoarse ; 
great thirst ; complains of weakness in bowels ; tongue warm, white ; 
pulse indistinct, but perceptible. 

Camphor at intervals of ten minutes. 
25th, half-past twelve, a.m. — Purged once ; vomited four times, 
faeces like butter -milk ; heat in stomach ; coldness in throat ; pulse 
perceptible,. quick and small ; ineffectual desire to sleep ; no urine ; 
cramps continue. 

Arsenic, 3, and Veratrum, 3, 
alternately, every quarter of an hour. 
Ten, a.m. — Much cramped till four this morning; no urine; 
bowels twice opened, faeces white, like thick gruel, foetid ; vomited 
three times; tongue and skin warmer; pulse 100, small. 
Continue medicine. 
Three, p.m. — No urine ; feels a little sick ; painful sensation over 
the region of the bladder ; the other symptoms gone. 

Digitalis and Arsenic alternately every hour. 
25th, ten, p.m. — No better; much pain at lower part of abdo- 
men ; had three stools since last visit of whitish flocculent liquid ; 
no urine ; vomited several times the water she drinks ; thirst ; pulse 
small, weak, about 96. 

Arsenic hourly. 
26th, two, p.m. — Vomiting greenish fluid ; bowels very open ; 
pulse 96, weak ; skin dry and cold. 

Continue. 
27th, half-past eight, a.m. — Pulse 84 ; skin warm; voice still 
hoarse ; one scanty bilious stool; vomited three or four times, green- 
ish water ; no cramps ; slept none ; urinated a little this morning. 
Ipecacuanha, 3, hourly. 
Eleven, a.m. — Urinated an hour ago ; much thirst and vomiting. 

Arsenic hourly. 
28th, nine, a.m. — Slept well ; urinated twice ; no vomiting nor 
purging ; pulse 80 ; skin and tongue still inclined to be cold. 

Continue. 
Half-past two, p.m. — No vomiting ; bowels moved twice ; stools 
thin and yellow ; less thirst ; feels hungry. 

29th. — Urinated freely ; bowel complaint gone ; feels well, except 
weakness ; very hungry. 



:; ^; ^U^MB^Bl ! $M 



APPENDIX. 333 



Case LVL 



T. S., aged 40, a tailor. — Said to be of temperate habits, but admits 
he was drinking on Saturday ; has had some pain in the bowels and 
diarrhoea for the last few days ; seized 26th November, four, p.m. 
First seen half-past nine, p.m. Vomiting of everything taken ; 
purging after drinking ; matter vomited and purged is a colourless 
fluid with white flakes ; urinated a little time ago ; pulse quick, 
perceptible, weak ; hands coolish ; tongue pale, rather cold ; breath 
warm; a little pain in the lower part of the belly ; no cramps ; com- 
plains of general uneasiness. 

Camphor every ten minutes. 

27th, half-past eight, a.m. — No purging since twelve o'clock last 
night ; urinated sparingly about eleven, p.m. ; vomited frequently, 
especially after drinking ; great insatiable thirst ; pulse perceptible 
but indistinct ; trembling of the whole body ; skin colder ; tongue 
and breath warm ; voice fuller and stronger ; says he has no pain, 
complains only of thirst. 

Arsenic, 3, every half-hour. 

One, p.m. — Pulse 90, weak; skin warmer; no urine; less vomit- 
ing and thirst. 

Camphor every quarter of an hour. 

Half-past nine, p.m. — Still sick ; no urine ; less thirst ; slept 
quietly, at intervals, this evening ; skin and tongue warm ; pulse 
92 ; uneasy. 

Arsenic, 3, every half-hour. 

28th, half-past eight, a.m. — Slept a good deal through the night; 
vomiting at times, especially after drinking ; purged once ; has not 
urinated ; pulse perceptible but indistinct ; skin warmer. 

Continue. 

Two, p.m. — General heat pretty good ; pulse rather indistinct ; 
bowels opened, dejections white ; urinated three hours ago. 

Continue. 

Seven, p.m. — Says he feels " queer," but is in good spirits ; pass- 
ed urine ; thirst much abated ; heat natural, 

29th, eight, a.m. — Slept well ; urinated twice ; purged once, stool 
brown and faeculent ; pulse 74 ; feels languid ; no pain ; bad taste 
in mouth. 

Mercurius, 3d, every four hours. 



334 APPENDIX. 

30th, noon. — Slept a good deal yesterday, restless through the 
night ; urinated freely ; bowels regular ; hungry ; pulse 88. 

1st Dec, seven, a.m. — Slept well and feels better. 

2d. — Up and feels well — better, he says, than he has done for 
some time. 

Case LVII. 

C. S., a woman aged 23. — Lying in the same bed with a woman 
who died of cholera. Attended and dressed the body of a patient 
who died of cholera ; has been sick and purging ever since. Was 
seized 27th November, eight, a.m. First seen same day, three, p.m. 
Severe cramps in the feet and legs ; almost continuous vomiting and 
purging ; evacuations watery ; giddiness ; sense of soreness and 
pressure over the stomach ; passed very little urine ; eyes much 
sunk, with dark-blue areola ; pulse small, at times imperceptible ; 
hands and arms cold. 

Camphor every ten minutes for half an hour, then 
Veratrum, 3d, half-hourly. 
Ten, p.m. — Tongue and face cold ; cramps in legs ; great thirst ; 
restless ; bowels opened twice ; urinated at noon ; pulse small and 
indistinct. 

Arsenic, 3d, every half-hour. 
28th, eight, a.m. — Slept a little through the night ; cramps in 
legs and right arm ; great thirst, vomiting after drinking ; bowels 
once moved, stool consisting of about two ounces of reddish fluid ; 
pulse 112, fuller; tongue rather warmer; voice clearer; no urine ; 
less lividity of face. 

Continue Arsenic, Camphor occasionally. 
Noon. — Thirst and vomiting still continue ; no purging ; great 
abortive desire to urinate a little time ago. 

Continue. 
Half-past three, p.m. — Sighing and breathlessness ; pained above 
the right haunch; very thirsty; vomiting whitish watery fluid; 
pulse 120, feeble. 

Continue. 
Nine, p.m. — Eestless and tossing about, suffering from cramps in 
front of the left leg ; moaning ; vomited twice watery fluid, with 
white mealy sediment ; urinated three hours ago ; eyes sunk ; vacant 
dark countenance ; sighing frequently ; skin cold and dry ; pulse 
120, weak. 



APPENDIX. 335 

Continue. 
Ten, p.m.— Inclined to purge, but cramps come on when she at- 
tempts to rise ; thirst less ; looks better ; face warmer ; catamenia 
have come on. 

Continue. 
29th, half-past nine, a.m.— Slept from twelve to five this morn- 
ing, when she had some cramps in the front of the legs ; skin warm, 
except the arms, which are lying bare ; face warm ; vomiting only 
after taking cold water; retains the Camphor; urinated through 
the night ; bowels not moved ; pulse 124, weak. 

Continue. 
One, p.m. — Very sick, vomited twice or thrice ; severe pain in 
belly; headach ; pulse 110, weak; tongue warm. 

Continue. 
30th, one, p.m.— -Slept well ; bowels not moved ; urinated freely ; 
pulse 88 ; heat of skin natural. 

Continue. 
Four, p.m. — Better. 

Six, p.m. — Continues to improve; no purging nor vomiting; still 
thirsty, took some gruel this afternoon, and felt sick. 
Bryonia, 3d, every two hours. 
1st Dec, six, a.m. — Bowels not moved. 
Eight, p.m. — Much better ; able to walk about. 
2d Dec, eleven, a.m. — Is up ; bowels costive. 

Nux, 3d. 
Ten, p.m. — Going about well. 

Case LVIIL 
Mrs. G., aged forty-five. Intemperate. Attacked 28th Novem- 
ber, two, p.m. First seen, seven, p.m. Frequent purging, evacua- 
tions watery; nausea and almost constant vomiting; breathing op- 
pressed ; heart's action weak ; pulse weak, but perceptible ; aspect 
described by her daughter as much altered ; tongue cold ; voice 
natural ; no urine for twelve hours. 

Camphor every ten minutes. 
Ten, p.m.— Tongue cold ; two brown, bilious stools ; very sick 
some cramps in legs ; pulse 80. 

Mercurius, 3d, every four hours. 
29th, nine, a.m.— Slept a little through the night; pulse 106; 



336 APPENDIX. 

skin warm ; tongue cold ; severe cramps and vomiting ; purging 
dark greenish water as she lies ; no urine. 

Arsenic, 3d, every hour. 
Two, p.m. — Pulse 96, small ; cramps abated ; skin warm ; face 
and tongue cold ; less vomiting ; purged three or four times. 

Continue. 
Twelve, p.m.— -Still sick; some pain in legs; no urine; pulse 
.104; skin warm, except the face; purged three times; is faint 
when she attempts to rise ; dry retching ; pain in stomach, increased 
on pressure and by cough ; stools scanty, white. 
Mercurius, 3d, every hour. 
30th, noon. — Slept well last night ; urinated once ; no motion of 
bowels; pulse 92; still vomiting; frequent abortive desire to re- 
lieve bowels and to urinate. 

Nux Vomica, 3d, every two hours. 
Four, p.m. — Giddiness ; no purging ; pulse 96. 

Continue. 
1st December, seven, a.m. — Sick all night; vomiting this morn- 
ing ; skin warm. 

Continue. 
Nine, a.m. — Nausea. 
Seven, p.m. — Much better. 

Continue. 
2d, noon. — Still vomiting when she raises her head ; purging a 
little ; urinated last night. 

Arsenic every two hours. 
Three, p.m. — Better ; sitting up attending her daughter. 
4th. — Pulse 84. of good strength ; feels well, though weak. 

Case LIX. 

C. L., aged forty-four. — Has been attending a case of cholera. 
Of such dissipated habits that her family, who are in respectable 
circumstances, cannot have her with them. About three, p.m., 6th 
December, she was seized. First seen, 7th December, one, a.m. 
Feeling of coldness over the whole body ; violent shiverings and 
cramps; constant sickness, vomited seven or eight times since 
seizure ; purging several times (dejections not seen) ; urinated a 
little time ago; great thirst; heart's action weak; pulse 74, weak; 
skin cold, shivering violently ; tongue cold ; giddy. 



■f+^'W* 



APPENDIX. 337 

Camphor every quarter of an hour. 
Eight, a.m. — Pulse 100; hands and tongue warm; great pain in 
epigastrium, increased on pressure ; vomiting ; no purging since last 
visit ; cramps continue, but less severe ; giddiness ; thirst and head- 
ach ; urinated about an hour ago ; constant nausea ; slept none ; 
still shivering during the cramps. 

Ipecacuan., 3d, hourly. 
Six, p.m. — Great thirst ; much pain in the belly, with continual 
eructations; pulse 120, weak. 

Continue alternately with Aconite. 
8th, eight, a.m. — Some pain during the night ; feels better this 
morning ; temperature of the skin natural. 

10th. — Better; still some pain after food, which is regurgitated 
in mouthfuls. 

Nux, 3d, night and morning. 

Case LX. 

Mrs. A., aged fifty-six. A case of cholera occurred in the house 
previously. Has had bowel complaint since yesterday morning, 7th 
December, at six o'clock. Vomiting began last night about ten, 
with cramps in different parts of the body. First seen 8th Decem- 
ber, three, a.m. She says that for four hours she did not know 
where she was, and thought " she was lost ;" purging brown, foetid, 
watery liquid ; watery vomiting ; cramps in legs, arms, back, and 
neck; very thirsty : quick, oppressed breathing ; pulse 120, weak; 
face dark ; skin dry and cold ; voice husky. 

Mercurius, 3d, every quarter of an hour. 
Six, a.m. — Much better; pulse 100; perspired profusely; bowels 
moved twice, with desire to vomit ; stools whitish, watery, offensive. 
Continue every half-hour. 
Ten, a.m. — Stools thin, brownish, fcetid ; pulse 100 ; skin warm ; 
voice stronger ; no urine. 

Arsenic, 3d, every half-hour. 
Four, p.m. — Urinated abundantly at two, p.m. ; pulse 92, weak ; 
thirsty ; says she is better. 

Continue. 
Eleven, p.m. — Much the same ; bowels not moved. 
9th, eight, a.m. — Slept pretty well ; bowels not moved ; urinated 
twice. 

Y 



338 APPENDIX. 

Continue. 
Three, p.m. — Better ; feels inclined to rise. 

She has had a foul ulcer on the left ankle for many years. Medi- 
cine to be continued on account of it. 

Case LXI. 

E. B., a woman, aged thirty-three. Her child died of cholera 
yesterday morning. Was quite well last night when she went to 
bed. At three this morning, 10th December, she was seized with 
bowel complaint ; faeces ran from her before she could rise, since has 
purged every fifteen to twenty minutes, stools reported at first na- 
tural in appearance, latterly of clear water ; vomiting commenced 
at the same time ; cramps about an hour afterwards ; vomited 
during the visit clear water, which ran from her without much 
retching in a continuous stream ; complains of pain in the side ; 
much cramped in the calves of the legs ; no urine since last night ; 
pulseless ; respirations eighteen per minute ; has taken camphor 
since four, a.m., every ten minutes without improvement ; skin 
cold ; tongue pale and cold ; breath cold. 

Seven, a.m. — A bottle containing water saturated with Arseni- 
uretted Hydrogen was held to her nose for a few seconds ; in a little 
time the cramps ceased ; no other change. 

Arsenic, 3d, every quarter of an hour. 

Nine, a.m. — No change ; two or three fits of cramps ; vomited 
and ptfrged once. 

Continue. 

Noon. — Lying in a supine position, breathing slowly and calmly, 
without elevation of the thorax; face dark, cold; tongue and 
breath cold. 

Continue. 

Three, p.m. — Was retching during the visit, and vomited a large 
quantity of watery fluid ; pulse 92. 

Continue. 

Five, p.m. — Purging and vomiting rather less ; lying quiet ; 
pulse perceptible ; in other respects the same. 

Continue. 

1 1 th, nine, a.m. — No purging ; little vomiting for four hours ; 
tongue cold; pulse 100, weak; cramps in legs. 

Continue. 



APPENDIX. 339 

Four, p.m. — Pulse 82, fuller; tongue and skin warmer ; vomited 
once ; no purging. 

Continue. 
12th, half-past eight, a.m. — Rested quietly till three, A.M. ; pulse 
92, pretty full ; tongue dry ; body warm ; no urine ; severe pain 
in bowels, increased on pressure ; face blue ; bowels once moved ; 
no vomiting. 

Arsenic, 3d, and Bryonia, 3d, alternately every half-hour. 
Two, p.m. — Very uneasy, and still cramps in the bowels. 

Continue. 
13th, nine, A.M. — Slept a good deal ; much less thirst ; feels very 
weak; pulse 100, sharp, but tolerably strong; tongue moist, cool ; 
no oppression of chest; urinated for the first time yesterday at 
three, p.m. ; dry retching ; bowels moved last night and again this 
morning, stool faeculent. 

Continue. 
One, p.m. — Pulse 1 00 ; complains only of weakness ; no vomit- 
ing nor purging. 

Continue. 
Half-past nine, p.m. — Nausea after drinking ; tongue moist ; 
urinated very freely ; feels hungry. 

Continue. 
14th, half-past nine, a.m. — Rested pretty well ; pulse 90, very 
weak ; tongue moist, pretty clean ; thirsty ; complains only of 
weakness ; urinated ; bowels not moved since last night. 
To have a spoonful of sago every two hours. 
Two, p.m. — Bowels not moved ; feels better ; pulse 92 ; face 
much flushed. 

Continue Ars. and Bryon. 
Half-past four, p.m.— Still nausea and thirst ; in other respects 
unchanged. 

Continue. 
Nine, p.m. — Continuing better. 

15th, nine, a.m. — Rested well; pulse 86, weak; feels herself 
stronger this morning ; still no motion of bowels ; urinating freely. 
Nux Vomica, 3d, three times a day. 
16th. — Bowels not opened. 

Continue. 
17th, nine, a.m. — Bowels costive ; continuing to improve. 



340 APPENDIX. 

Half-past eleven, a.m. — Sitting up in bed, says she is well. 

Continue. 
18th. — Pulse slow, weak ; bowels opened once yesterday. 

Continue. 
19tb. — Gradually gaining strength ; sitting up part of the day ; 
bowels costive. 

Continue. 
20th. — Continuing well. 

Case LXII. 

J. P., aged 50. — A fatal case of cholera occurred in this stair 
last week, and he has been in attendance on a patient who died. 
Bowel complaint began on Tuesday, accompanied with giddiness. 
He has been taking Camphor since Thursday, and Mercurius yes- 
terday. To-day the bowel complaint became much more severe ; 
stools copious, thin, reported of a brownish-yellow colour, very 
foetid ; great thirst, has been getting hot water to drink ; vomiting 
began 10th December, three, p.m.; seen at nine, p.m.; vomited 
three or four times a dark-red liquid with a sour smell ; urinated 
scantily three or four times during the day, last time about three 
hours ago ; no pain, heat, nor coldness in bowels ; throat very dry 
and sore when swallowing spittle ; speaks as if his mouth was 
parched ; when the abdomen is compressed the wind rumbles from 
side to side ; vomits a few minutes after drinking ; feels excessive- 
ly restless, and wishes for change of posture ; skin warm ; face 
anxious, dusky ; tongue warm, covered with a dark fur ; pulse 82, 
weak, fullest in the right arm ; respirations 22, abdominal ; alter- 
nate respirations feeble ; voice weak. 

Arsenic, 3d, and Veratrum, 3d, alternately every half-hour. 

11th, nine, a.m. — Passed a restless night; vomited four or five 
times before four, a.m., not since; constant purging; stools like 
thin rice water, foetid ; pulse 84 ; pain and uneasiness in epigas- 
trium preventing rest ; less thirst. 

Continue. 

Half-past four, p.m. — Has been pretty well all day till about an 
hour ago, when the uneasy feelings returned ; faeces of the same 
colour ; no vomiting. 

Continue. 

12th, nine, a.m. — Had a restless night, felt drowsy but could not 



APPENDIX. 341 

sleep ; medicine made him sick ; frequent desire to purge, stools 
slightly fasculent ; frequent abortive desire to urinate, the urine 
passed is scalding ; thirst much less ; pulse 88, pretty full ; feeling 
of emptiness in stomach, and frothy vomiting. 
Secale, 3d, hourly. 

Two, p.m. — Doing well ; urine still scalding. 

Eight, p.m. — Scalding gone. 

13th, nine, a.m. — Restless night; some purging, stools fa?culent; 
pulse 88, good strength; tongue furred ; empty retching; uneasi- 
ness in epigastrium, increased on pressure ; urinating freely. 
Continue Secale. 

Nine, p.m. — Sitting up in bed taking sago ; feels better. 

14th. — Feels much better. 

Case LXIII. 

Mrs. D., aged 56. — Has been ill with bowel complaint since yes- 
terday morning ; everything she takes passes from her bowels un- 
digested ; she has a constant desire to evacuate, with cutting pains, 
headach, nausea, and inclination to vomit. Was seized on the 15th 
December, at twelve, p.m., with severe cramps in the feet, legs, and 
right arm, and in the stomach, w T ith a feeling as if she was going to 
be choked. First seen at seven, p.m., 15th December. The cramps 
are somewhat diminished, but there is still severe pain in the 
stomach ; sensation of choking ; tongue clean and adhesive ; face 
has a dusky appearance ; eyeballs leaden-coloured ; dejections fre- 
quent, of a brownish colour ; has urinated regularly, but scantily ; 
pulse 86 ; great thirst. 

Arsenicum, 3, every half-hour. 

1 6th, five, p.m. — Cramps returned with great severity at three 
o'clock, (some one gave her brandy) ; they continue now unabated ; 
it is scarcely possible to hold her in bed, from the intensity of the 
cramps ; has been vomiting incessantly for an hour. 

Continue, with Yeratrum alternately, half-hourly. 

Nine, a.m. — Nausea ; vomited and purged twice since last visit ; 
pulse 92, stronger; skin warmer; slight cramps. 

Omit Yeratrum : continue Arsenic. 

Half-past eleven, p.m. — Yomiting everything taken ; no purging 
since last visit ; cold ; cramps less severe. 

Continue. To drink warm water. 



342 APPENDIX. 

17th, half- past nine, a.m. — Snatches of sleep through the night ; 
cramps less severe, vomiting after drinking; constant nausea; 
purged four times; stools reported to consist of dirty water; skin 
much warmer ; pulse 98 ; tongue warm ; no urine ; cramps recur 
with the vomiting. 

Continue. 
Noon. — Still thirsty, and sick after drinking water ; tongue warm, 
covered with white fur ; pulse 96. 

Continue. 
18th, eleven, a.m. — No vomiting since last night ; bowels moved 
once this morning ; stools brownish, watery ; urinated at eight, a.m. ; 
skin warm ; tongue and breath warm ; is flushed in the face ; tongue 
white ; coughing, and expectorating yellow thick mucus. 

Two, p.m. — No vomiting nor purging since last visit ; complains 
greatly of pain in right inguinal region ; great sickness and inclina- 
tion to vomit ; body warm ; face flushed. 

Bryon., 3, every two hours. 
Nine, p.m. — Pain in side, checking breath ; tongue moist ; urinated 
twice; bowels moved in the morning; pulse 104, rather full. 

Continue. 
20th, one, p.m. — Ts better ; complains of sickness on raising her 
head. 

Ipecacuan., 3. 
2 2d. — Recovered. 

Case LXIV. 

R. IT., aged 19, a soldier. — Was quite well when he went to bed 
last night, 1 5th December. Woke about twelve, p.m., his abdomen 
swelled and hard ; vomiting and purging, with slight cramps in legs, 
came on; felt better m the morning. About three, p.m., 16th De- 
cember, the vomiting and purging returned ; has had no appetite 
to-day. Seen first same day, twelve p.m. Great thirst ; vomiting 
after drinking ; stools reported of thick mucus ; no urine since yes- 
terday ; cramps, severe in calves, come on in paroxysms every fifteen 
to twenty minutes ; nausea, especially when purging, and giddiness ; 
pulse 104, full; respirations 18; tongue white, bloodless, cold; 
burning heat in throat ; copious purging of brownish water. 
Arsenic, 3, and Cuprum Aceticum, 3, 
alternately every half-hour. 

17th, eight, a.m. — Slept none ; cramps very frequent and severe 



APPENDIX. 343 

all night ; vomiting of watery fluid in large quantities, especially 
after drinking ; purged eight or nine times, stools watery, with a 
grey flocculent cloud ; voice unaltered ; frequent sighing ; no livi- 
dity ; skin and tongue warm ; no urine ; great thirst ; coustant 
nausea; pulse 78, fluttering. 

Arsenic, 3, and Veratrum, 3, alternately every half-hour. 

Three, p.m. — Voice husky ; tongue and breath cold ; pulse weak ; 
complains of oppression in chest ; very thirsty; vomits and purges 
after drinking cold water; still cramped in the front of the legs; 
asking for food. 

Omit Veratrum: continue Arsenicum. 

18th, half-past eleven, a.m. — Better; skin, tongue, and breath 
warm ; no vomiting since midnight, when he was very restless, got 
up, and fainted ; when put into bed again, he was anxious to be up. 
About one, a.m., fell asleep ; awoke repeatedly, but lay pretty 
quietly till eight, when his bowels moved, and he urinated; the 
stool copious liquid, of a dirty orange colour, with flakes; voice still 
rather husky. Has taken a few tea-spoonfuls of sago. 

Continue Arsenic. Camphor in water occasionally. 

Ten, p.m. — Urinated at five, p.m. ; bowels not moved ; skin cold. 
Continue. 

19th, half-past nine, a.m. — Bowels twice opened ; stools thin and 
watery ; feels better, and hungry. 

Continue. 

20th, noon. — After taking a little sago yesterday was sick, and 
vomited ; no purging ; vomiting green water this morning. 
Ipecacuan., 3. 

21st, nine, a.m. — Much better; vomiting stopped; bowels still 
very open. 

22d. — Very weak, but quite convalescent ; and, as he is staying 
at a friend's house, removed to Castle Hospital. 

Case LXV. 

Mrs. Mc, aged 25. — A miserable cellar. The woman lying on 
straw, with very little covering. Intemperate. Taken ill on the 
l?th December, with purging, which continued till four, a.m., of 
the 20th, when it became much more violent, and accompanied by 
vomiting. Had cramps in the legs. First seen, three, p.m., of the 
20th. Purging and vomiting dark watery liquid ; surface cold ; 



344 APPENDIX. 

hands shrivelled ; face sunk and cold ; tongue moist, covered with 
a yellowish white fur ; pulse imperceptible ; complains of great 
thirst, and pain in legs ; passed urine this morning ; voice hoarse. 
Arsenic, 3, and Secale, 3, alternately every half-hour. 
Eleven, p.m. — Yomiting and purging less urgent ; still complains 
of pain in leg, says it is less severe ; surface warmer ; pulse percep- 
tible, but indistinct ; great nausea and thirst. 

Continue. 
21st, half-past eight, a.m. — Voice stronger and clearer; vomits 
only after drinking; feels very sick; pulse 100, stronger; skin 
warm ; very little purging ; urinated at two, a.m. 

Continue. 
One, p.m. — Pulse 84 ; skin warm ; feels sick, but more comfort- 
able ; had no purging nor vomiting since last visit. 

Continue. 
22d, nine, a.m. — Pulse 82, weak ; complains of chilliness and 
sickness ; no purging nor vomiting ; urinated through the night ; 
skin and tongue feel warm. 

Continue. 
23d. — Pulse 90 ; no purging, vomiting, nor urine since last visit ; 
took some food ; felt sick after it. 

24th. — Pulse natural ; slept well ; urinated freely ; feels hungry; 
sickness gone. 

26th. — Up and well, though weak. 

Case LXVI. 

E. S., a woman, aged 24. — On 22d December, at seven, p.m., 
was suddenly seized with violent cramps in the stomach, (felt as if 
the whole body was drawn together) ; in a few minutes the feet, 
legs, and hands became severely cramped ; giddiness, nausea, and 
empty retching ; great tossing of the body, and nervous excite- 
ment. First seen at nine, p.m. ; she had just taken gt. 20 of solu- 
tion of morphia. Skin hot and moist ; feet and hands severely 
cramped ; frequent cramps in the stomach ; vomiting a liquid like 
rice-water ; great thirst ; oppression at the chest ; face red ; eyes 
inflamed and suffused with tears ; beating at the temples ; crying 
out from pain in the head, and wishing her hair to be taken out ; 
pulse 110, small ; suppression of urine. 



; ^ ^H* 8 ^^ 



APPENDIX. 345 

Camphor, two doses. 
Arsenic, 3, and Cuprum, 3, alternately. 
Half-past ten, p.m. — Became quiet, and rested for half an hour, 
after which all the symptoms returned with great violence, particu- 
larly the cramps in the feet and legs ; as the cramps disappeared 
she became very sick, and vomited a rice-water looking fluid. 

Continue. 
23d, two, a.m. — Long, deep inspirations ; mouth wide open ; eyes 
turned up ; pulse almost imperceptible. 

Half-past two, a.m. — Complained of pain in head ; moaning 
heavily. 

Belladonna, 3, every half-hour. 
Nine, a.m. — Slept from five to six, moaning at times ; pulse small 
and weak. 

Arsenic, 3, every half-hour. 
Two, p.m. — Had one return of cramps in hands and toes ; com- 
plains of great sinking at the heart ; pain in the back ; urinated 
twice to-day ; frequent shivering and moaning ; skin warm and 
moist ; tongue red in the middle, furred at the edges ; eyes red. 

Continue. 
Nine, p.m. — Dozing at times ; restless. 

24th, ten, a.m. — Much better ; pain in epigastrium, and coldness 
in the back. 

Nux Vomica,3, 
Nine, p.m. — Still improving; been up for some time. 
26th. — Quite well. 

Case LXVII. 

J. McN., aged 47. — Has been exposed to cold, and is in destitute 
circumstances. Has had bowel complaint for two days, with fre- 
quent abortive desire to purge. At five, p.m., 30th December, the 
bowel complaint became very severe ; about ten, p.m., began to 
vomit. First seen, 31st December, half-past eight, a.m. Vomits 
everything taken ; very severe cramps all over the body, especially 
in the hands and legs ; has not urinated since last night ; faeces 
watery, nearly colourless, foetid ; vomiting of watery fluid ; com- 
plained of cold and shivering, though the skin was warm. Expres- 
sion anxious ; face dusky, inclined to be cold ; eyes sunk, with dark 
areola; tongue furred, cold ; hands shrivelled, dusky, and cold; body 



346 APPENDIX. 

cool ; very great thirst ; pulse 104, very weak ; complains of pains 
in the belly, with feeling of burning in the stomach at times. Res- 
pirations 30, oppressed ; heaving ; cramps return on the least 
motion ; purging as he lies. Has taken camphor without benefit. 
Arsenic, 3d, Secale, 3d, alternately every quarter of an hour. 
Half-past one, p.m. — Feels easier ; less vomiting ; thirst still very 
great; purging continues; no urine; pulse 9.5, stronger; skin and 
tongue warmer ; cramps less, both in frequency and severity. 

Continue. 
Half-past nine, p.m. — Skin and tongue ice-cold ; pulse imper- 
ceptible ; cramps very severe, especially in legs and hands ; great 
retching ; purging continues. 

Arsenic, 3d, and Cuprum Aceticum, 3d, every half-hour. 
1st January 1849, half-past eight, a.m. — Slept at intervals during 
the night ; had abortive desire to urinate this morning ; cramps 
continue, but much less severe ; watery vomiting continues ; purg- 
ing rather less ; pulse 100, small and weak ; tongue warmer ; skin 
warm. 

Continue. 
2d, noon. — Vomited an hour ago ; watery and colourless purging 
during the night ; headach ; no urine ; pulse rather weaker than 
yesterday. 

Continue Arsenicum; omit Cuprum Acet. 
Eight, p.m. — Feels better ; pulse a little improved ; vomiting and 
purging nearly subsided ; urinated at half-past seven, p.m. 

Continue. 
3d, nine, a.m. — Pulse 60, rather weak; hiccoughing; pain in 
epigastrium, much worse on pressure; tongue moist, bluish; no 
cramps ; urinated last night. 

Bryonia, 3d, every hour. 
4th, three, p.m. — Hiccough continues ; pulse very weak ; urinated 
freely ; bowels not moved. 

Arsenicum, 3d, and Nux, 3d, alternately every hour. 
Eleven, p.m. — Hiccough abated ; vomiting at times a watery, 
scalding fluid ; pulse 68, very weak ; restless. 
Continue Arsenic. 
5th, ten, a.m. — Urinating freely, but hiccough returned; pulse 
weak ; bowels not moved. 

Continue Arsenic, alternately with Cicuta, 3d. 



APPENDIX. 347 

6th. — Hiccough continues, but less severe ; urinating freely ; 
bowels once moved, faeces thin ; pulse 72, stronger ; less thirst. 
Nux Vomica, 3d, every two hours. 
7th, four, p.m. — Hiccough continues, but much less severe ; uri- 
nating freely ; bowels once moved ; pulse 78, stronger ; skin warm ; 
has been taking porter, which brought on sickness. 

Continue. 
8th, eleven, a.m. — Sitting by the fire ; hiccough continues ; pulse 
stronger. 

Bellad., 3d, every two hours. 
9th, eleven, a.m. — Still hiccoughing; pulse small ; tongue furred ; 
skin hot. 

Rhus, 3d, every two hours. 
] Oth, ten, a.m. — Sleeping ; tongue dry, glazed ; pulse 94, weak ; 
hiccough much abated. 

Continue. 
11th, eleven, a.m. — Stronger; tongue clean; one natural stool; 
occasional attacks of hiccough. 

Continue. 
12th, half-past ten, a.m. — Sitting up in bed; hiccough still 
troublesome ; vomited barley, which he took yesterday ; one stool ; 
urinating freely. 

Continue. 
13th, nine, a.m. — Much better; hiccough gone; feels hungry. 

Omit medicine. 
1 5th. — Continuing free from hiccough ; complains only of weak- 
ness. 

Case LXVIII. 

Mrs, T., aged 28.— Quite well last night. Felt unwell first, 3d 
January, eleven, p.m. ; purging and vomiting began at twelve, p.m. 
First seen 4th January, four, a.m. Dejections copious, white, like 
rice-water ; watery vomiting ; no urine since last night ; cramps 
in legs excited by motion ; skin and face cold ; eyes sunk ; pain in 
left side ; pulseless ; has not vomited for an hour ; great thirst. 
Camphor, every quarter of an hour. 

Eleven, a.m. — No purging ; frequent vomiting of green water ; 
pulse 120 ; surface warm, tongue warm ; no urine, nor cramps ; 
feels better. 



348 APPENDIX. 

Veratrum, 3d, and Arsenicum, 3d, alternately every half-hour. 

Ten, p.m. — Pulse 78, weak ; no purging ; vomiting of green 
water continues ; she is nursing, and her milk, which had disap- 
peared, has returned ; tongue furred, cool ; great thirst ; slept a 
little this afternoon ; face natural in temperature and colour. 
Continue Arsenic. 

5th, eleven, a.m. — Slept well ; urinated at five, a.m. ; bowels 
once moved ; stool reported yellow ; pulse 72 ; less thirst ; warm ; 
feels hungry. 

8th. — Up, and feels better, though weak and giddy occasionally. 

Case LXIX. 

D. S., aged 5. — This boy's mother died of cholera last week, in 
Glasgow ; he, his brothers, and sisters, were brought here by his 
grandmother on Thursday last. A man in this house took cholera 
on that day, was removed to the hospital, and died. An old man 
also died on Saturday of cholera, and his body is at present lying 
in the house. This child has been purging since Friday. Last 
night, 6th January, about eight, p.m., the purging became very 
severe ; milk, water, and wine, which were given him, passed un- 
digested. First seen 7th January, five, p.m. Stools frequent, 
watery; vomiting everything taken, and large quantities of watery 
fluid ; complains of pain in epigastrium ; urine reported to be very 
scanty ; skin and tongue cold ; face cold, dark-coloured ; eyes 
deeply sunk; expression anxious; moaning; pulse about 120, weak, 
at times scarcely perceptible ; very great thirst. Has been warmer 
since taking some brandy two hours ago. 

Arsenic, 3, every half-hour. 

8th, eleven, a.m. — Pulse 110; bowels four times moved since 
visit ; stools (last one) dark, faeculent ; urinated this morning ; vo- 
mited twice ; less thirst ; voice clearer ; skin tolerably warm ; tongue 
warmer. 

Continue. 

9th, eleven, a.m. — "Was hungry last night, and had some gruel 
without producing sickness ; slept well ; wishes to rise this morn- 
ing ; pulse 80, natural ; temperature of skin natural ; tongue clean ; 
urinating freely ; bowels twice moved ; stools brown, liquid ; no 
thirst. 

12th. — Sitting up ; quite well ; appetite good. 



APPENDIX. 349 

Case LXX. 
Mr. K., aged 26. — Had nausea and vomiting through the night, 
with cramps in the abdomen and pains in the epigastrium. Seized 
at five, a.m., 9th January; first seen ten, a.m. Yomiting large 
quantities of whitish watery matter ; purged once very profusely ; 
pain in abdomen and epigastrium ; shaking and chattering his teeth ; 
great thirst ; breath cool ; pulse quick and weak ; skin cold ; no 
urine since early in the morning. 

Camphor, every quarter of an hour. 
Three, p.m. — Still sick ; vomited twice, but free from pain ; pulse 
fuller and regular. 

Ipecacuanha, hourly. 
10th, ten, a.m. — Yery thirsty; vomited this morning watery 
liquid in abundance ; frontal headach. 

Nux Vomica, 3, every two hours. 
Nine, p.m. — Shaking involuntarily; skin warmer; thirsty. 

Continue. 
11th. — Much better; to have arrow-root. 
12th. — Continuing to improve. 
13th. — Up, sitting at fireside; feels hungry. 

Case LXXI. 

W. C, aged 27. — A day-labourer, of tolerably sober habits, living 
in a very poor and wretched garret. Has had bowel complaint for 
several days. Seized 14th January, eight, a.m. ; first seen two, p.m. 
Purging very severe ; stools copious and watery, with a feeling of 
cold ; sickness ; cramps in the legs and abdomen ; pulse 60, weak ; 
tongue very white, loaded, and clammy, cold ; tenderness of the 
abdomen on pressure ; passed no urine since last night ; very sick ; 
vomited very frequently white mucus, tinged with bile; stools 
colourless ; complaining of frontal headach. 

Nux Vomica, 3d, every hour. 

Nine, p.m. — Pulse more distinct; cramps not so frequent nor 
severe ; purging and vomiting still continue. 
Arsenic, 3d, every hour. 

15th, ten, a.m. — Had a bad night; vomiting and purging con- 
tinue ; no cramps ; tongue cleaner ; pulse 100 ; face a little flushed ; 
less tenderness of the abdomen ; stools more feculent, and passed 
urine. 



350 APPENDIX. 

Continue. 
Six, p.m. — Slept a little ; no headach, nor cramps ; purging con- 
tinues, with tenesmus ; stools more faeculent ; tongue cleaner ; occa- 
sional sickness still continues. 

Mercurius, 3d, every hour. 
16th, ten, a.m. — Slept pretty well ; feels much better ; pulse 68, 
good strength ; feels weak ; has taken some gruel ; no sickness 
after it ; purging continues, but much less severe ; urinating freely. 

Continue. 
1 9th. — Completely recovered. 

Case LXXII. 

W. N., aged twenty-five. — A sawyer. "Was drinking for the last 
three days, and taking scarcely any food. 27th January, two, p.m., 
felt sick, and vomited three times a large quantity of bloody liquid, 
with cramps in the abdomen and attacks of syncope ; took castor 
oil at four, p.m., with laudanum ; vomited it ; his bowels became 
loose, without pain ; about seven, p.m., the stools were copious and 
bloody. Seen first at eleven, p.m. He was pale, ghastly, and cold ; 
pulse languid, and scarcely perceptible ; very thirsty ; epigastrium 
tender ; tongue, lips, and breath cold ; expression anxious. Up- 
wards of a pint of blood, with coagula, was passed from the rectum 
after three painless stools ; no urine since morning. 

Camphor occasionally, and Mercurius, 3d, every hour. 

28th,* eleven, a.m. — Warmer; pulse weak, 98; face and lips 
pale; less thirst; bowels moved twice; stools still bloody; says 
he feels better ; urinated this morning at seven. 

Continue. 

Half-past seven, p.m. — Bowels not moved ; pulse 84 ; skin cold ; 
thirsty. 

Continue. 

29th, half-past one, p.m. — Went out to work, but obliged to re- 
turn in two hours, from pain in the epigastrium. 

Continue. 

30th. — Better ; feels sick when sitting up ; bowels not moved. 

31st. — Quite well. 

Case LXXIII. 
Mrs. -A., aged eighty-five. — A tall woman, bent double, but still 



'^-^^'^0i¥W^'- ' 



APPENDIX. 351 

cheerful and healthy, except the right ankle-joint, from which there 
is a grumous, watery discharge, as if from ulceration of the cartil- 
ages, though it often heals up. About a month ago, the ankle be- 
came swelled and painful ; the swelling went up as far as the knee, 
and assumed an erysipelatous type. Now recovered. Last night, 
21st January, she felt sick, and shivered ; frequent vomiting of the 
water drank ; severe purging of a greenish, brown, watery liquid ; 
stools passed involuntarily in bed. First seen, 2 2d January, six, 
p.m. She had great thirst, was apparently sinking, being cold, 
powerless, and dejected ; said she was dying ; pulse 1 08, very weak, 
and intermittent. . 

Camphor occasionally ; Arsenic, 3d, every hour. 

23d, nine, a.m. — Passed an easier night ; stools less frequent ; 
still very sick ; skin a little warmer. 

Continue. 

Ten, p.m. — No urine since last night ; less thirst ; bowels moved 
four times ; stools offensive. 

Continue. 

24th, ten, a.m. — Bowels not moved till six this morning, when she 
urinated ; no pain in ankle-joint ; pulse quick. 

Continue. 

Eight, p.m. — A little better ; bowels open ; tenesmus ; skin dry, 
warm; nausea continues. 

Merc. 3, every two hours. 

25th, noon. — Bowels moved six times ; stools scanty, bilious ; 
has urinated. 

Continue. 

26th, eight, a.m. — Worse ; took porridge for supper last night ; 
feels sick, and has tenesmus. 

Continue. 

Ten, p.m. — Up, sitting at the fire. 

27th. — Bowels open three times ; stools scanty ; is hungry. 

28th. — Is better ; sitting up and cheerful ; pain in ankle returned. 

29th. — One natural stool. 

30th. — Says she is quite well. 

1 st February. — Continues well. 

Case LXXIV. 
J. D., aged forty-two. — His mother and brother died of cholera 



352 APPENDIX. 

in December last. He is a notorious drunkard. Has been drink- 
ing all last week, and taking very little food. Diarrhoea came on 
three days ago. Took opium, rhubarb, and Allopathic mixtures, 
which were vomited; took brandy and beer, which were also vomited. 
Both yesterday and to-day, 1 1th February, purging has been severe; 
stools liquid, copious, watery, white ; vomiting everything taken. 
Cramps in both legs since three this afternoon. First seen at ten, 
p.m. Countenance dark and pinched ; eyes sunk, open ; tongue, 
lips, and breath cold ; the pulse barely perceptible ; voice hoarse 
and feeble; can scarcely turn his head, from exhaustion. The 
purging has been involuntary since five or six this afternoon, and 
he thinks himself dying. 

Camphor diffused in water to drink. 
Arsenic, 3, every half-hour. 
12th, seven, a.m. — Found sitting at the fireside; cold like ice; 
pulse very weak and thready ; says he is easier when up, and freer 
from cramps when stooping forward ; had no sleep last night ; no 
vomiting nor purging since visit, and is less thirsty. 
Continue. Ordered to go to bed. 
Nine, p.m. — Much warmer ; pulse distinct, but very weak ; bowels 
not moved ; no urine since yesterday morning. 

Continue. 
13th, nine, a.m. — Says he feels better, but not stronger ; urinated 
abundantly this morning ; bowels not moved. 

Continue. 
Five, p.m. — Pulse 1 08, firmer ; skin warm, more natural in colour, 
and the countenance composed. 

Continue. 
14th, ten, a.m. — Slept well last night ; bowels once moved ; stool 
liquid, brown, offensive; pulse 96. 

Continue. 
15th, two, p.m. — Was restless last night ; perspired towards morn- 
ing; pulse 88, soft. 

Continue. 
Eleven, p.m. — Says he is well ; took beef-tea, and feels stronger 
since ; pulse 82, firm. 

16th. — Up, and expressing gratitude for his rapid recovery. 

The following is a case of recovery from the typhoid stage. 



mm, 



APPENDTX. 35S 

It was one of our earliest cases, and being seen by all of us very 
frequently, there was not so accurate a report kept by any one of 
us as we could desire. It was looked upon as quite hopeless. 

Cask LXXV. 
Mrs. L., aged 35, seized with vomiting, and purging, and cramps 
in the arms and legs, at four o'clock, p.m., of 10th October; seen 
at six, p.m. She had violent convulsive fits, lasting from five to teu 
minutes, with fixed eyeballs, clenching of the jaws, and slight foam- 
ing at the mouth. Her pulse was irregular, varying every few 
minutes from 104 to 68 beats per minute. Abdomen exceedingly 
tender. 

Aeon, and Nux Vom., alternately every quarter of an hour. 
Nine, same evening. — No convulsions or cramps ; abdomen still 
tender; only one stool; no vomiting; pulse 100, weak, regular. 
Continued to improve until the 12th, when she seemed convalescent. 
On the night of the 12th she went about the house, and ate potatoes. 
At twelve, p.m., was seized with violent cramps in the limbs and 
pain in the abdomen. She was seen at half-past one, a.m., and 
found cold, and purging and vomiting. 

Got Nux Vom., and Verat., and fell asleep. 
When seen at five, a.m., she was in a state of perfect collapse, 
and not expected to live above a few hours. 
She was ordered Arsen. 
On the 14th, at four, a.m., the upper part of the body was quite 
cold ; there was no purging and little vomiting ; no pulse ; and 
hiccough. 

Secale and Verat. alternately. 
At ten, a.m., same day, the pulse was just perceptible; tongue 
and breath not quite so cold. She was seen from this time by one 
of the medical officers every three or four hours for several succeed- 
ing days, and got chiefly 

Arsenicum and Veratrum. 
The symptoms gradually abated, but for several days the weak- 
ness was so great that she was not expected to recover. She gradu- 
ally got better, and when seen on the 23d of November was quite 
well. She passed through the true typhoid stage. 

z 

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ELEMENTS OF GENERAL PATHOLOGY. 

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